Provider Demographics
NPI:1417258344
Name:MAHMOUDIANI, SHAHRIAR (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHRIAR
Middle Name:
Last Name:MAHMOUDIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SHAHRIAR
Other - Middle Name:ABOLGHASEM
Other - Last Name:MAHMOUDIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 W 4TH ST
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4002
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:107 W 4TH ST
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4002
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255748207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology