Provider Demographics
NPI:1780048769
Name:MILANI-NEJAD, SHADI (DO)
Entity type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:MILANI-NEJAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 RIVERWALK PKWY STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3370
Mailing Address - Country:US
Mailing Address - Phone:951-785-7190
Mailing Address - Fax:951-688-7246
Practice Address - Street 1:4234 RIVERWALK PKWY STE 280
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3370
Practice Address - Country:US
Practice Address - Phone:951-785-7190
Practice Address - Fax:951-688-7246
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A160242084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology