Healthcare Provider Details

I. General information

NPI: 1740785070
Provider Name (Legal Business Name): SABA AFSHAR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST UNIT 610
LOUISVILLE KY
40202-5711
US

IV. Provider business mailing address

4216 JENA ST
NEW ORLEANS LA
70125-4434
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4865
  • Fax:
Mailing address:
  • Phone: 504-666-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042-0015938
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR4640
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: