Provider Demographics
NPI:1215386008
Name:NIA, SHAHNAZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:
Last Name:NIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 PIERCE ST NE UNIT 1244
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3062
Mailing Address - Country:US
Mailing Address - Phone:404-971-2435
Mailing Address - Fax:
Practice Address - Street 1:9110 RAILROAD DR STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-7041
Practice Address - Country:US
Practice Address - Phone:703-365-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015170122300000X
VA0401415874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist