Provider Demographics
NPI:1760522791
Name:NAZARIAN, SHAHRZAD SHERRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAHRZAD
Middle Name:SHERRY
Last Name:NAZARIAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6314
Mailing Address - Country:US
Mailing Address - Phone:718-444-8151
Mailing Address - Fax:718-444-8151
Practice Address - Street 1:86 EAST 49TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-604-5402
Practice Address - Fax:718-363-6647
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5761213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPH6033Medicare UPIN