Provider Demographics
NPI:1306911573
Name:EISNER, SHAZNEEN KEYAMANESH (MD)
Entity type:Individual
Prefix:
First Name:SHAZNEEN
Middle Name:KEYAMANESH
Last Name:EISNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAZNEEN
Other - Middle Name:JAL
Other - Last Name:KEYAMANESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5709
Mailing Address - Country:US
Mailing Address - Phone:978-663-3410
Mailing Address - Fax:978-670-8110
Practice Address - Street 1:505 MIDDLESEX TPKE UNIT 3
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3578
Practice Address - Country:US
Practice Address - Phone:978-663-3410
Practice Address - Fax:978-670-8110
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3157172Medicaid
MA3157172Medicaid
MAEIA21676Medicare ID - Type Unspecified