MEDICARE: BAHAREH SHANEHSAZ 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	208000000X	Pediatrics Physician	25MA10301200	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649666165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAHAREH SHANEHSAZ M.D.

Provider Business Mailing Address
First Line	:	196 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-1672
Country	:	US
Telephone Number	:	609-799-5335
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-1672
Country	:	US
Telephone Number	:	609-799-5335
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	06/10/2020

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Directions to “ BAHAREH SHANEHSAZ M.D.” Practice Location

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