Provider Demographics
NPI:1407595564
Name:SHAFIYAN-RAD, SARINA
Entity Type:Individual
Prefix:DR
First Name:SARINA
Middle Name:
Last Name:SHAFIYAN-RAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 BROADWAY STE 8
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3579
Mailing Address - Country:US
Mailing Address - Phone:781-231-2100
Mailing Address - Fax:
Practice Address - Street 1:855 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3579
Practice Address - Country:US
Practice Address - Phone:781-231-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18594471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program