Healthcare Provider Details

I. General information

NPI: 1073173530
Provider Name (Legal Business Name): SHIMA TAFRESHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

23 SPRAIN VALLEY RD
SCARSDALE NY
10583-3105
US

V. Phone/Fax

Practice location:
  • Phone: 914-924-5867
  • Fax:
Mailing address:
  • Phone: 914-924-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number312118-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: