Provider Demographics
NPI:1205305208
Name:VASY, SHAHRZAD
Entity type:Individual
Prefix:DR
First Name:SHAHRZAD
Middle Name:
Last Name:VASY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 BARBARA ANN WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2487
Mailing Address - Country:US
Mailing Address - Phone:302-437-4286
Mailing Address - Fax:
Practice Address - Street 1:11011 MANKLIN CREEK RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-4010
Practice Address - Country:US
Practice Address - Phone:410-641-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005337183500000X
MD26174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26174OtherIMMUNIZING PHARMACIST LICENSE
DEA1-0005337OtherIMMUNIZING PHARMACIST LICENSE