Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | C1-0012673 | DE |
N | 208000000X | Pediatrician | A140317 | CA |
N | 208000000X | Pediatrician | C1-0012673 | DE |
Y | 2080P0206X | Pediatric Gastroenterologist | C1-0012673 | DE |
N | 2080P0206X | Pediatric Gastroenterologist | MD468912 | PA |
NPI | 1104266931 |
---|---|
Provider Name | Dr. Shaida Nasiri-Blomgren |
First Address | Wilmington, DE 19803-3607 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 19/04/2020 |