Individual
SHADI SERAJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
130 MERRICK RD, LYNBROOK, NY 11563-2740
(516) 596-7600
Mailing address
130 MERRICK RD, LYNBROOK, NY 11563-2740
(516) 596-7600
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
305809
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881041127
—
NY
Enumeration date
05/17/2016
Last updated
04/25/2023
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