Provider Demographics
NPI:1790896330
Name:SHEMIRANI, MEHDI (MDFACS)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:SHEMIRANI
Suffix:
Gender:M
Credentials:MDFACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 PORTLAND AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3002
Mailing Address - Country:US
Mailing Address - Phone:585-342-6310
Mailing Address - Fax:585-342-3245
Practice Address - Street 1:1360 PORTLAND AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3002
Practice Address - Country:US
Practice Address - Phone:585-342-6310
Practice Address - Fax:585-342-3245
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1005001208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74844Medicare UPIN
NY32715BMedicare ID - Type Unspecified