Individual
BAHAREH SHANEHSAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
196 PRINCETON HIGHTSTOWN RD, WEST WINDSOR, NJ 08550-1672
(609) 799-5335
Mailing address
196 PRINCETON HIGHTSTOWN RD, WEST WINDSOR, NJ 08550-1672
(609) 799-5335
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA10301200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2858100
—
NJ
Enumeration date
04/10/2015
Last updated
06/10/2020
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