Provider Demographics
NPI:1922386887
Name:NAKSHABANDI, FIRAS ABDUSSALAM (MD)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:ABDUSSALAM
Last Name:NAKSHABANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 BELMONT ST BLDG 5
Mailing Address - Street 2:(116A7) PSYCHIATRY EDUCATION ATTN: MARIE
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5596
Mailing Address - Country:US
Mailing Address - Phone:508-583-4500
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST BLDG 5
Practice Address - Street 2:(116A7) PSYCHIATRY EDUCATION ATTN: MARIE
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:508-583-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249139390200000X
IL0361364932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program