Provider Demographics
NPI:1215167507
Name:SHAHIDI, MARIAM (RN, LIC AC)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:RN, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-B HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-2642
Mailing Address - Country:US
Mailing Address - Phone:508-877-0188
Mailing Address - Fax:
Practice Address - Street 1:76 B HARRINGTON ROAD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-2642
Practice Address - Country:US
Practice Address - Phone:508-877-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist