Provider Demographics
NPI:1154063022
Name:YEGANEH, SHAHRZAD (DMD)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:YEGANEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ESTERMALKA
Other - Middle Name:
Other - Last Name:YEGANEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:73 WILMOT CIR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6721
Mailing Address - Country:US
Mailing Address - Phone:310-213-5116
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-952-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program