MEDICARE: SHIMA RASTEGAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	339005	NY

General Provider Information

NPI Number	:	1114555240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIMA RASTEGAR MD

Provider Business Mailing Address
First Line	:	1216 5TH AVE FL 3
Second Line	:	PATHOLOGY DEPARTMENT
City	:	NEW YORK
State	:	NY
Zip	:	10029-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 5TH AVE FL 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-5202
Country	:	US
Telephone Number	:	332-265-0350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	10/13/2025

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