Healthcare Provider Details

I. General information

NPI: 1043605397
Provider Name (Legal Business Name): SHAHNAZ MIRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-3456
US

IV. Provider business mailing address

2186 GEARY BLVD STE 210
SAN FRANCISCO CA
94115-3456
US

V. Phone/Fax

Practice location:
  • Phone: 415-800-4178
  • Fax: 415-800-4942
Mailing address:
  • Phone: 415-800-4178
  • Fax: 415-800-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA181700
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberA181700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: