Provider Demographics
NPI:1831210434
Name:SHAHIDI, MANI (PA)
Entity type:Individual
Prefix:
First Name:MANI
Middle Name:
Last Name:SHAHIDI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5057
Mailing Address - Country:US
Mailing Address - Phone:303-940-9118
Mailing Address - Fax:303-940-5943
Practice Address - Street 1:6342 E GEDDES AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1536
Practice Address - Country:US
Practice Address - Phone:720-529-9758
Practice Address - Fax:561-498-5856
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical