Provider Demographics
NPI:1689810384
Name:SHAH, FARIBA (MD)
Entity Type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FARIBA
Other - Middle Name:
Other - Last Name:EMAMHOSSEINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-570-7415
Mailing Address - Fax:301-570-7416
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 155
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-570-7415
Practice Address - Fax:301-570-7416
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73443208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation