Provider Demographics
NPI:1508811704
Name:SHAMSNIA, MORTEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:
Last Name:SHAMSNIA
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 1:2905 KINGMAN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6615
Mailing Address - Country:US
Mailing Address - Phone:504-885-3737
Mailing Address - Fax:504-885-5507
Practice Address - Street 1:2905 KINGMAN ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6615
Practice Address - Country:US
Practice Address - Phone:504-885-3737
Practice Address - Fax:504-885-5507
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07415R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368521Medicaid
LA53360Medicare ID - Type Unspecified
LA1368521Medicaid