Provider Demographics
NPI:1851928071
Name:MZADEH, SANAZ (MD)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:MZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANAZ
Other - Middle Name:
Other - Last Name:MOHAMMADZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 LAFAYETTE RD APT 424
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2903
Mailing Address - Country:US
Mailing Address - Phone:804-814-5069
Mailing Address - Fax:
Practice Address - Street 1:111 LAFAYETTE RD APT 424
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2903
Practice Address - Country:US
Practice Address - Phone:804-814-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program