Provider Demographics
NPI:1518067677
Name:MAHDAVIANI, SHEILA (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:MAHDAVIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:275 S ARROYO PKWY
Mailing Address - Street 2:APT # 218
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-5209
Mailing Address - Country:US
Mailing Address - Phone:601-209-2484
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5331
Practice Address - Country:US
Practice Address - Phone:601-442-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS19377207W00000X
CAA103379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology