Healthcare Provider Details

I. General information

NPI: 1093434029
Provider Name (Legal Business Name): SHAHRZAD HEYDARZADEH ZAVAREMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PIEDMONT DR E
TALLAHASSEE FL
32308-7949
US

IV. Provider business mailing address

1430 PIEDMONT DR E
TALLAHASSEE FL
32308-7949
US

V. Phone/Fax

Practice location:
  • Phone: 850-224-6496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME173096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: