Provider Demographics
NPI:1851506596
Name:SEDGH, SHAHRYAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:
Last Name:SEDGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4502
Mailing Address - Country:US
Mailing Address - Phone:718-384-2662
Mailing Address - Fax:718-384-6408
Practice Address - Street 1:738 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4502
Practice Address - Country:US
Practice Address - Phone:718-384-2662
Practice Address - Fax:718-384-6408
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice