Provider Demographics
NPI:1447337555
Name:MEHDI, SHAZIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:
Last Name:MEHDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GEYSER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3022
Mailing Address - Country:US
Mailing Address - Phone:518-583-3553
Mailing Address - Fax:515-583-4676
Practice Address - Street 1:409 GEYSER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12020-3022
Practice Address - Country:US
Practice Address - Phone:518-583-3553
Practice Address - Fax:515-583-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602922Medicaid