# MIRHAIDARI FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154859924
- **Authorized official:** SHADY TAGGART (BILLING)
- **Authorized official phone:** (330) 364-8884

## Contact information

- **Practice address:** 152 N BROADWAY ST STE 100, NEW PHILADELPHIA, OH 44663-2665
- **Practice address phone:** (330) 364-8884
- **Mailing address:** 152 N BROADWAY ST STE 100, NEW PHILADELPHIA, OH 44663-2665
- **Mailing address phone:** (330) 364-8884

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 34-008184 | OH | Yes |
| 363L00000X | Nurse Practitioner | APRNCNP15213 | OH | — |

## Other

- **Enumeration date:** 05/24/2017
- **Last updated:** 05/24/2017