Provider Demographics
NPI:1710062245
Name:LEILABADI, SHAHRIYAR A (MD)
Entity Type:Individual
Prefix:
First Name:SHAHRIYAR
Middle Name:A
Last Name:LEILABADI
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-8431
Mailing Address - Fax:
Practice Address - Street 1:9924 NE 185TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3502
Practice Address - Country:US
Practice Address - Phone:425-595-3830
Practice Address - Fax:425-595-3831
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242080207Q00000X
WAMD60556970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061129000052OtherFIDELIS CARE #
WA2087778Medicaid
NY000528841001OtherHEALTH NOW BCBS #
NY070320000059OtherFIDELIS CARE URGENT CARE#
NY00027738401OtherUNIVERA #
NY0145379OtherGHI PPO #
NY194882BFOtherPREFERRED CARE #
NY0114050OtherIHA #