Provider Demographics
NPI:1477727741
Name:SHAHIDI, LORI ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MIRON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7826
Mailing Address - Country:US
Mailing Address - Phone:817-488-1950
Mailing Address - Fax:817-305-0162
Practice Address - Street 1:305 MIRON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7831
Practice Address - Country:US
Practice Address - Phone:817-488-1950
Practice Address - Fax:817-305-0162
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM96482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195601301Medicaid
TXP00736997OtherRAILROAD MEDICARE
TX8X5113OtherBCBS
TXP00736997OtherRAILROAD MEDICARE