Provider Demographics
NPI:1891525499
Name:MIRZAKASHANI, NINA SAHAR
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:SAHAR
Last Name:MIRZAKASHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 21ST ST RM 1003
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-396-3996
Practice Address - Street 1:19 W 21ST ST RM 1003
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6843
Practice Address - Country:US
Practice Address - Phone:917-740-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85853512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty