Basic Information
| Provider Information | |||||||||
| NPI: | 1689810384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | FARIBA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EMAMHOSSEINI | ||||||||
| OtherFirstName: | FARIBA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18109 PRINCE PHILIP DR | ||||||||
| Address2: | SUITE 155 | ||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015707415 | ||||||||
| FaxNumber: | 3015707416 | ||||||||
| Practice Location | |||||||||
| Address1: | 18109 PRINCE PHILIP DR | ||||||||
| Address2: | SUITE 155 | ||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015707415 | ||||||||
| FaxNumber: | 3015707416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2008 | ||||||||
| LastUpdateDate: | 11/11/2015 | ||||||||
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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 | 208100000X | D73443 | MD | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.