Provider Demographics
NPI:1518000389
Name:ASVADI, SHAHLA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:ASVADI
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 1:140 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6306
Mailing Address - Country:US
Mailing Address - Phone:508-879-8128
Mailing Address - Fax:508-879-3837
Practice Address - Street 1:140 LINCOLN ST.
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-879-8128
Practice Address - Fax:508-879-3837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52195207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A57120Medicare UPIN