MEDICARE: SHAYZREEN M ROSHANRAVAN 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	207V00000X	Obstetrics & Gynecology Physician	M4490	TX
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	M4490	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861502627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYZREEN M ROSHANRAVAN MD

Provider Business Mailing Address
First Line	:	4700 DEXTER DR STE 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5299
Country	:	US
Telephone Number	:	972-596-3242
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 DEXTER DR STE 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5299
Country	:	US
Telephone Number	:	972-596-3242
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/17/2013

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