Provider Demographics
NPI:1699531483
Name:AZIZI, SHUJAWODIN (RN)
Entity type:Individual
Prefix:
First Name:SHUJAWODIN
Middle Name:
Last Name:AZIZI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BROOK RUN DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3531
Mailing Address - Country:US
Mailing Address - Phone:516-361-6512
Mailing Address - Fax:
Practice Address - Street 1:30 BROOK RUN DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3531
Practice Address - Country:US
Practice Address - Phone:516-361-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse