Provider Demographics
NPI:1063807352
Name:YARI, SHAHRAM SHAWN
Entity type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:SHAWN
Last Name:YARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7064
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:469-800-7210
Practice Address - Street 1:5220 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7064
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:469-800-7210
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT3414207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program