Provider Demographics
NPI:1639798739
Name:SHIRAZI, ZAINAB
Entity type:Individual
Prefix:
First Name:ZAINAB
Middle Name:
Last Name:SHIRAZI
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 1:290 REVOLUTION DR APT 800
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1683
Mailing Address - Country:US
Mailing Address - Phone:708-567-8875
Mailing Address - Fax:
Practice Address - Street 1:20 GUEST ST STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2040
Practice Address - Country:US
Practice Address - Phone:617-475-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023664208100000X
COTL0010042390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation