Healthcare Provider Details

I. General information

NPI: 1902339229
Provider Name (Legal Business Name): SARA SHAPOURAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 ROCHAMBEAU AVE FL 4
BRONX NY
10467-2841
US

IV. Provider business mailing address

90 BERGEN ST SUITE 5200
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number311278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: