Provider Demographics
NPI:1669834743
Name:MIRAFZALI, SHAHRZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRZAD
Middle Name:
Last Name:MIRAFZALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHAHRZAD
Other - Middle Name:MAGHSOUDLOO
Other - Last Name:MIRAFZALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE 3-5
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-235-2550
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE 3-5
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-235-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist