Provider Demographics
NPI:1275641870
Name:BORHAN-MANESH, SHAHRZAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:BORHAN-MANESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARY
Other - Middle Name:
Other - Last Name:BORHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9520 W PALM LANE
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-556-8860
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:3400 N DYSART RD
Practice Address - Street 2:STE 121
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-583-3001
Practice Address - Fax:623-583-3007
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ581463Medicaid
I70188Medicare UPIN
AZZ143595Medicare PIN