Healthcare Provider Details

I. General information

NPI: 1245408038
Provider Name (Legal Business Name): DJAMSHID SHIRAZIAN MPH, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4603 MIDDLE COUNTRY RD 12-3 SUNY INCUBATOR,
CALVERTON NY
11933
US

IV. Provider business mailing address

4603 MIDDLE COUNTRY RD 12-3 SUNY INCUBATOR,
CALVERTON NY
11933
US

V. Phone/Fax

Practice location:
  • Phone: 917-518-1983
  • Fax: 718-635-7088
Mailing address:
  • Phone: 917-518-1983
  • Fax: 718-635-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberSHIRD1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: