Provider Demographics
NPI:1215915517
Name:SHAHLAIE, KIARASH (MD)
Entity type:Individual
Prefix:
First Name:KIARASH
Middle Name:
Last Name:SHAHLAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY
Mailing Address - Street 2:4860 Y STREET, SUITE #3740
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3071
Mailing Address - Fax:916-452-2580
Practice Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY
Practice Address - Street 2:4860 Y STREET, SUITE #3740
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-3071
Practice Address - Fax:916-452-2580
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79635207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery