Provider Demographics
NPI:1164689873
Name:MOJAHEDI, SHAHRAM (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:
Last Name:MOJAHEDI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 WARD PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3366
Mailing Address - Country:US
Mailing Address - Phone:816-389-6030
Mailing Address - Fax:816-389-6034
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:816-389-6030
Practice Address - Fax:816-389-6034
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1383341041367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1383341041OtherKS RN LICENSE
MO2000169846OtherMO RN LICENSE