Provider Demographics
NPI:1962792515
Name:MIRHAIDARI, SHAYDA (MD)
Entity type:Individual
Prefix:MISS
First Name:SHAYDA
Middle Name:
Last Name:MIRHAIDARI
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 1:3925 EMBASSY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1799
Mailing Address - Country:US
Mailing Address - Phone:330-668-4065
Mailing Address - Fax:
Practice Address - Street 1:4466 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2864
Practice Address - Country:US
Practice Address - Phone:330-668-4065
Practice Address - Fax:330-668-4082
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128792208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery