Healthcare Provider Details

I. General information

NPI: 1649214529
Provider Name (Legal Business Name): AMIR H SHAHLAEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534A JOHN MARR DR
ANNANDALE VA
22003-3308
US

IV. Provider business mailing address

11002 VEIRS MILL ROAD, SUITE 414 INSTITUTE FOR ASTHMA AND ALLERGY
WHEATON MD
20902
US

V. Phone/Fax

Practice location:
  • Phone: 301-962-5800
  • Fax: 301-962-9585
Mailing address:
  • Phone: 301-962-5800
  • Fax: 301-962-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD57508
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME92043
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0057508
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: