Healthcare Provider Details

I. General information

NPI: 1760360226
Provider Name (Legal Business Name): SHAHRAD TAHERI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

13271 SW 29TH CT
DAVIE FL
33330-1243
US

V. Phone/Fax

Practice location:
  • Phone: 954-853-2760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number14
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: