Provider Demographics
NPI:1396775730
Name:NABIZADEH, SHAHRIAR A (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHRIAR
Middle Name:A
Last Name:NABIZADEH
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:PO BOX 16373
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6373
Mailing Address - Country:US
Mailing Address - Phone:904-723-5665
Mailing Address - Fax:904-723-5653
Practice Address - Street 1:801 OAK ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4317
Practice Address - Country:US
Practice Address - Phone:904-723-5665
Practice Address - Fax:904-723-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72727208VP0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250010395OtherMEDICARE RAILROAD
FL252411200OtherMEDIPASS
FL373007700OtherDEPT OF LABOR WORKCOMP
FL593590543OtherUNITED HEALTHCARE
FL2168186OtherAETNA
FL593590543OtherCIGNA
FL235909OtherAVMED HMO
FL252411200Medicaid
FL41489OtherBLUE CROSS BLUE SHIELD
FL252411200OtherMEDIPASS
FLG53462Medicare UPIN