Provider Demographics
NPI:1356761340
Name:MIRSHAHI, SHAGHAYEGH (MD)
Entity type:Individual
Prefix:
First Name:SHAGHAYEGH
Middle Name:
Last Name:MIRSHAHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MANHATTANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2113
Mailing Address - Country:US
Mailing Address - Phone:203-635-2002
Mailing Address - Fax:
Practice Address - Street 1:2 MANHATTANVILLE RD
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2113
Practice Address - Country:US
Practice Address - Phone:203-635-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-06-29
Deactivation Date:2018-04-11
Deactivation Code:
Reactivation Date:2018-04-17
Provider Licenses
StateLicense IDTaxonomies
VA0101264340207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine