Individual provider Active NPI

Shaheen Mehrara, DO

  • Student in an Organized Health Care Education/Training Program
  • Dallas, TX
National Provider Identifier
1780379990
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
1404812417 Issued in TX
Practice address
1441 N Beckley Ave
Dallas, TX 75203-1201
Phone
(214) 947-8181
NPI assigned
Apr 5, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training ProgramGroup: 193400000X SINGLE SPECIALTY GROUP 390200000X 1404812417 TX Primary

Addresses

Primary practice location

1441 N Beckley Ave
Dallas, TX 75203-1201

Mailing address

808 Sweetgum CT
Hoover, AL 35244-1621
Phone (205) 790-2051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230606001288 TX Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8729445853

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1404812417TXMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1780379990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 SWEETGUM CT",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352441621",
            "telephone_number": "205-790-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N BECKLEY AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031201",
            "telephone_number": "214-947-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHRARA",
        "first_name": "SHAHEEN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-05",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "1404812417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.