MEDICARE: MRS. SHIVA RAHIMI - SHAHMIRZADI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639548886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIVA RAHIMI - SHAHMIRZADI M.D.

Provider Business Mailing Address
First Line	:	3435 MAIN ST.
Second Line	:	105 PARK HALL SOUTH CAMPUS
City	:	BUFFALO
State	:	NY
Zip	:	14216
Country	:	US
Telephone Number	:	716-838-5889
Fax Number	:	716-838-4918

Provider Business Practice Location Address
First Line	:	3435 MAIN ST.
Second Line	:	105 PARK HALL SOUTH CAMPUS
City	:	BUFFALO
State	:	NY
Zip	:	14216
Country	:	US
Telephone Number	:	716-838-5889
Fax Number	:	716-838-4918

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	04/21/2016

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