Provider Demographics
NPI:1356414148
Name:SHAHRIARI, KUROSH REX (EDD)
Entity type:Individual
Prefix:
First Name:KUROSH
Middle Name:REX
Last Name:SHAHRIARI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3298
Mailing Address - Country:US
Mailing Address - Phone:641-792-4012
Mailing Address - Fax:641-791-0697
Practice Address - Street 1:306 N 3RD AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3298
Practice Address - Country:US
Practice Address - Phone:641-792-4012
Practice Address - Fax:641-791-0697
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00382103T00000X
IA00059103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10251Medicare ID - Type Unspecified