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General NPI Number Information
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NPI Number | 1083685937
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Entity Type | Organization
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Legal Business Name | SHARIAR SOTUDEH MD PC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 153 STEVENS AVE STE 5
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2543
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Country | US
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Telephone | 914-667-1620
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Fax | 914-667-2421
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | MOUNT VERNON
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State | NY
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Zip | 10552-0536
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Country | US
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Telephone | 914-667-1620
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Fax | 914-667-2421
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Authorized Official
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Title or Position | DR
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Name | DR. SHARIAR SOTUDEH
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Credential | M D
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Telephone | 914-667-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 124255
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License Number State | NY
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