Provider Demographics
NPI:1275794984
Name:HOSSEINI, SHAHLA MARIE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:MARIE
Last Name:HOSSEINI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3694
Mailing Address - Fax:
Practice Address - Street 1:7690 DISCOVERY DR
Practice Address - Street 2:SUITE 3500
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-418-2707
Practice Address - Fax:513-418-2698
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193759208100000X
OH35.121229208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation