Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME 116632 | FL |
N | 2080P0214X | Pediatric Pulmonologist | ME 116632 | FL |
NPI | 1538360987 |
---|---|
Provider Name | Mitra Shafieian |
First Address | Cutler Bay, FL 33190-1003 |
Second Address | Cutler Bay, FL 33190-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 12/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009635800 | (05) | FL |