Provider Demographics
NPI:1477677045
Name:SHAYESTEH, LADAN (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:LADAN
Middle Name:
Last Name:SHAYESTEH
Suffix:
Gender:F
Credentials:DO MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:#1149 CONTEMPORARY FAMILY MEDICINE ASSOCIATES
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:240-223-2639
Mailing Address - Fax:240-223-3223
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:#1149
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:240-223-2639
Practice Address - Fax:240-223-3223
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0057083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018918C64Medicare ID - Type Unspecified
I49389Medicare UPIN