Basic Information
| Provider Information | |||||||||
| NPI: | 1265941769 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KIRATA | ||||||||
| FirstName: | SHIREEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | LAHEY INSTITUTE OF UROLOGY, DERRY | ||||||||
| Address2: | 44 BIRCH STREET | ||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034346380 | ||||||||
| FaxNumber: | 6034343626 | ||||||||
| Practice Location | |||||||||
| Address1: | LAHEY INSTITUTE OF UROLOGY, DERRY | ||||||||
| Address2: | 44 BIRCH STREET | ||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034346380 | ||||||||
| FaxNumber: | 6034343626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA6892 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 1312 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.