Healthcare Provider Details

I. General information

NPI: 1164080206
Provider Name (Legal Business Name): SEYEDEH SHADI SHOJAEI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHADI SHOJAEI MD

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

PO BOX 1806
ALLENTOWN PA
18105-1806
US

V. Phone/Fax

Practice location:
  • Phone: 484-862-3256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD479116
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT217788
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: