Healthcare Provider Details

I. General information

NPI: 1801082201
Provider Name (Legal Business Name): MAHNAZ SHAHIDI-ASL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TRANCAS ST
NAPA CA
94558-2906
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax:
Mailing address:
  • Phone: 800-288-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA93938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: