Healthcare Provider Details

I. General information

NPI: 1407088826
Provider Name (Legal Business Name): SHADI YAGHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3600
  • Fax: 732-897-3660
Mailing address:
  • Phone: 401-444-6440
  • Fax: 401-444-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA12753900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD14878
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: