Provider Demographics
NPI:1437973385
Name:FAHIMIRAD, FARNAZ (RDN, CDN)
Entity type:Individual
Prefix:MRS
First Name:FARNAZ
Middle Name:
Last Name:FAHIMIRAD
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 64TH RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3413
Mailing Address - Country:US
Mailing Address - Phone:917-794-9175
Mailing Address - Fax:
Practice Address - Street 1:6 E 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2401
Practice Address - Country:US
Practice Address - Phone:917-794-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012295-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered