Provider Demographics
NPI:1467431072
Name:ABEDI, SHAHLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:
Last Name:ABEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAREBLU
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3015
Mailing Address - Country:US
Mailing Address - Phone:949-831-4144
Mailing Address - Fax:949-831-6145
Practice Address - Street 1:15 MAREBLU
Practice Address - Street 2:SUITE 260
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3015
Practice Address - Country:US
Practice Address - Phone:949-831-4144
Practice Address - Fax:949-831-6145
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30819207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0218000002Medicare NSC
CAA30819Medicare ID - Type Unspecified