Provider Demographics
NPI:1295756419
Name:SHAHIDI, HOMAYOON (MD)
Entity type:Individual
Prefix:
First Name:HOMAYOON
Middle Name:
Last Name:SHAHIDI
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 1:6555 COYLE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0303
Mailing Address - Country:US
Mailing Address - Phone:916-962-1544
Mailing Address - Fax:
Practice Address - Street 1:75 PRINGLE WAY STE 801
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8400
Practice Address - Country:US
Practice Address - Phone:775-982-2820
Practice Address - Fax:775-982-2821
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8967207RX0202X
CAC53428207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13897788OtherCAQH ID
NV20119OtherMEDICAL LICENSE
CAC53428OtherMEDICAL LICENSE