Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00758000 | NJ |
NPI | 1194297069 |
---|---|
Provider Name | Dr. Melina Moaven Shahidi |
First Address | Jersey City, NJ 07310-1400 |
Second Address | Jersey City, NJ 07310-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |