Provider Demographics
NPI:1265770085
Name:SHAHNAZARIAN, VAHE SIS (MD)
Entity type:Individual
Prefix:DR
First Name:VAHE
Middle Name:SIS
Last Name:SHAHNAZARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2066 RICHMOND AVE STE 2L
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3961
Mailing Address - Country:US
Mailing Address - Phone:718-448-1122
Mailing Address - Fax:718-448-8318
Practice Address - Street 1:78 TODT HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4528
Practice Address - Country:US
Practice Address - Phone:718-448-1122
Practice Address - Fax:718-448-8318
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA138397207RG0100X
NY284847207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine