Provider Demographics
NPI:1699063057
Name:TORK, SHAHRYAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:
Last Name:TORK
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 1:8404 EUSTIS FARM LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-4214
Mailing Address - Country:US
Mailing Address - Phone:917-868-7875
Mailing Address - Fax:
Practice Address - Street 1:7136 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2617
Practice Address - Country:US
Practice Address - Phone:513-513-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP734208200000X
OH35132372208200000X
KY53280208200000X
OH35.130656208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery