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NPI Code Detail

MEDICARE: SHAYDA BOZORG

MEDICARE: SHAYDA BOZORG
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
1183500000XPharmacistPS44115FL

General Provider Information

NPI Number : 1487949152
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAYDA BOZORG
Provider Business Mailing Address
First Line : 4400 N STATE ROAD 7
Second Line : T-2146
City : CORAL SPRINGS
State : FL
Zip : 33073-3353
Country : US
Telephone Number : 954-366-2135
Fax Number : 954-366-2145
Provider Business Practice Location Address
First Line : 4400 N STATE ROAD 7
Second Line : T-2146
City : CORAL SPRINGS
State : FL
Zip : 33073-3353
Country : US
Telephone Number : 954-366-2135
Fax Number : 954-366-2145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 06/10/2011

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Directions to “ SHAYDA BOZORG ” Practice Location

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