Healthcare Provider Details

I. General information

NPI: 1982164349
Provider Name (Legal Business Name): DR. MEYSAM SHAYEGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY 2041 GEORGIA AVENUE NW ROOM 2066
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

3636 16TH ST NW APT B762
WASHINGTON DC
20010-1189
US

V. Phone/Fax

Practice location:
  • Phone: 626-633-2088
  • Fax:
Mailing address:
  • Phone: 626-633-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: