MEDICARE: SHAHROKH JAVAHERI 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	207RP1001X	Pulmonary Disease Physician	35048885	OH
2	207QS1201X	Sleep Medicine (Family Medicine) Physician	35.048885	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	311138782026	OTHER	CARESOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000011907	OTHER	BCBS - OH
4	4477146	OTHER	AETNA

General Provider Information

NPI Number	:	1407829757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHROKH JAVAHERI MD

Provider Business Mailing Address
First Line	:	4685 FOREST AVE
Second Line	:	SUITE C
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3359
Country	:	US
Telephone Number	:	513-853-4721
Fax Number	:	513-852-8525

Provider Business Practice Location Address
First Line	:	10496 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5223
Country	:	US
Telephone Number	:	513-793-2654
Fax Number	:	513-793-2962

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	01/29/2024

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