Provider Demographics
NPI:1427452465
Name:DOROUDI, SHIDEH (MD)
Entity type:Individual
Prefix:
First Name:SHIDEH
Middle Name:
Last Name:DOROUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2244
Mailing Address - Country:US
Mailing Address - Phone:862-336-1200
Mailing Address - Fax:862-236-1202
Practice Address - Street 1:1020 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2244
Practice Address - Country:US
Practice Address - Phone:862-336-1200
Practice Address - Fax:862-236-1202
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09499400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine