Provider Demographics
NPI:1609448455
Name:DEGHANI, SHABNAM (DO)
Entity Type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:DEGHANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SEAVIEW AVENUE
Mailing Address - Street 2:APT A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:347-972-9023
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW AVENUE, STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-05-19
Deactivation Date:2022-12-19
Deactivation Code:
Reactivation Date:2023-05-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program