Provider Demographics
NPI:1801936901
Name:NADERI, SHERVIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:NADERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1850 TOWN CENTER PARKWAY
Mailing Address - Street 2:SUITE 551
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-481-0002
Mailing Address - Fax:703-481-5002
Practice Address - Street 1:1850 TOWN CENTER PARKWAY
Practice Address - Street 2:SUITE 551
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-481-0002
Practice Address - Fax:703-481-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012384302082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck