Provider Demographics
NPI:1194297069
Name:MOAVEN SHAHIDI, MELINA (DC)
Entity type:Individual
Prefix:DR
First Name:MELINA
Middle Name:
Last Name:MOAVEN SHAHIDI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1400
Mailing Address - Country:US
Mailing Address - Phone:212-227-3233
Mailing Address - Fax:
Practice Address - Street 1:610 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1400
Practice Address - Country:US
Practice Address - Phone:212-227-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00758000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician