Provider Demographics
NPI:1609294396
Name:NABAVI NOURI, SHAYAN (MD)
Entity Type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:NABAVI NOURI
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 1:8718 BAY PARKWAY
Mailing Address - Street 2:FLOORS 1 AND 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3725
Mailing Address - Country:US
Mailing Address - Phone:718-266-0900
Mailing Address - Fax:718-266-1426
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:VC2-205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY28837207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program