Provider Demographics
NPI:1750039376
Name:BOZORGMEHRI, SHAHAB (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:BOZORGMEHRI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 W NEWBERRY RD APT P85
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2771
Mailing Address - Country:US
Mailing Address - Phone:352-328-2884
Mailing Address - Fax:
Practice Address - Street 1:13200 W NEWBERRY RD APT P85
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2771
Practice Address - Country:US
Practice Address - Phone:352-328-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program