Provider Demographics
NPI:1811280274
Name:YARANDI, SHADI SADEGHI (MD)
Entity type:Individual
Prefix:DR
First Name:SHADI
Middle Name:SADEGHI
Last Name:YARANDI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:FL 4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:410-933-6421
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:FL 4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:410-933-6421
Practice Address - Fax:410-933-1390
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD472225207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD83909OtherLICENSE