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General NPI Number Information
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NPI Number | 1467895474
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Entity Type | Individual
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Provider Name | SHALIZ POURKAVIANI MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 425 JACK MARTIN BLVD
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City | BRICK
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State | NJ
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Zip | 08724-7732
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Country | US
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Telephone | 407-491-8708
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Fax |
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Provider Business Mailing Address
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Address Line | 10259 TROUT RD
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City | ORLANDO
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State | FL
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Zip | 32836-6544
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Country | US
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Telephone | 407-491-8708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | A155765
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 285686
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME147211
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 25MA10989300
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License Number State | NJ
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