Healthcare Provider Details

I. General information

NPI: 1417104324
Provider Name (Legal Business Name): MEHDI SHARIFIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 WINTERBERRY DR
AUSTIN TX
78750-8332
US

IV. Provider business mailing address

7003 WINTERBERRY DR
AUSTIN TX
78750-8332
US

V. Phone/Fax

Practice location:
  • Phone: 512-858-4258
  • Fax:
Mailing address:
  • Phone: 512-858-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE4672
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: