Provider Demographics
NPI:1407829757
Name:JAVAHERI, SHAHROKH (MD)
Entity Type:Individual
Prefix:
First Name:SHAHROKH
Middle Name:
Last Name:JAVAHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:10496 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5223
Practice Address - Country:US
Practice Address - Phone:513-793-2654
Practice Address - Fax:513-793-2962
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048885207RP1001X
OH35.048885207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
311138782026OtherCARESOURCE
OH0521742Medicaid
000000011907OtherBCBS - OH
4477146OtherAETNA
311138782026OtherCARESOURCE
4016674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
000000011907OtherBCBS - OH
4477146OtherAETNA