Provider Demographics
NPI:1285823757
Name:SHEIBANI, SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:SHEIBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAHRAM
Other - Middle Name:SHANE
Other - Last Name:SHEIBANI-RAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6200 WILSHIRE BLVD STE 1702
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5818
Mailing Address - Country:US
Mailing Address - Phone:323-456-2600
Mailing Address - Fax:323-456-0160
Practice Address - Street 1:6200 WILSHIRE BLVD STE 1702
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5818
Practice Address - Country:US
Practice Address - Phone:323-456-2600
Practice Address - Fax:323-456-0160
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056075208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery