Provider Demographics
NPI:1598896029
Name:LODI, SHAHNAZ (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:
Last Name:LODI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1947
Mailing Address - Country:US
Mailing Address - Phone:607-235-2662
Mailing Address - Fax:888-390-0157
Practice Address - Street 1:2220 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1947
Practice Address - Country:US
Practice Address - Phone:607-235-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010673-1111N00000X
NY010673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC31334Medicare UPIN