Provider Demographics
NPI:1457371049
Name:ZAHEDI, SOHRAB (MD)
Entity Type:Individual
Prefix:
First Name:SOHRAB
Middle Name:
Last Name:ZAHEDI
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 1:6 FOREST PARK DR
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1480
Mailing Address - Country:US
Mailing Address - Phone:860-906-7969
Mailing Address - Fax:
Practice Address - Street 1:6 FOREST PARK DR
Practice Address - Street 2:SUITE # 5
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1480
Practice Address - Country:US
Practice Address - Phone:860-906-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0441262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001441260Medicaid