Provider Demographics
NPI:1922093095
Name:MAHINRAD, SHIVA (MD)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:MAHINRAD
Suffix:
Gender:F
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 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:11236 BAPTIST HEALTH DR STE 220
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2988
Practice Address - Country:US
Practice Address - Phone:904-696-6900
Practice Address - Fax:904-390-7502
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16011ZMedicare ID - Type Unspecified
FLI33005Medicare UPIN