NPIMap

Individual provider Active NPI

Shayda Mirhaidari, M.D.

  • Plastic Surgery Physician
  • Canton, OH
National Provider Identifier
1962792515
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
35.128792 Issued in OH
Practice address
4466 Fulton Dr NW
Canton, OH 44718-2864
Phone
(330) 668-4065
Fax
(330) 668-4082
NPI assigned
Apr 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 35.128792 OH Primary

Addresses

Primary practice location

4466 Fulton Dr NW
Canton, OH 44718-2864

Mailing address

3925 Embassy Pkwy Ste 300
Akron, OH 44333-1799
Phone (330) 668-4065

Other practice location 1

3925 Embassy Pkwy Ste 300
Akron, OH 44333-1799
Phone (330) 668-4065

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190724003163 OH Practitioner - Plastic and Reconstructive Surgery 9931435252 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Northeastern Ohio University College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crystal Clinic, Inc.Group PAC ID 7214821586, 46 clinicians

Practice addresses (Care Compare)

4466 Fulton Dr NW
Canton, OH 44718-2864
Phone (833) 334-9007

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy19
Melanoma (skin cancer) excision33
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Clinic, Inc. Plastic Surgery CurrentSince Dec 6, 2023 Accepting new patients
Crystal Clinic Orthopaedic Center LLC Plastic Surgery CurrentSince Jul 15, 2019 Accepting new patients
Summa Physicians LLC CurrentSince Nov 11, 2019 Accepting new patients
Crystal Clinic Orthopaedic Center LLC CurrentSince Jul 15, 2019 Accepting new patients
Summa Physicians LLC Current Accepting new patients
Crystal Clinic Inc CurrentSince Dec 6, 2023 Accepting new patients
Summa Physicians LLC CurrentSince Nov 11, 2019 Accepting new patients
Crystal Clinic Orthopaedic Center, LLC Past Accepting new patients

Locations

3975 Embassy Pkwy
Akron, OH 44333
Phone (330) 670-4242

3925 Embassy Pkwy
Ste 300
Akron, OH 44333
Phone (330) 668-4065

3975 Embassy Pkwy
Ste 202
Akron, OH 44333
Phone (330) 668-4085

525 E Market St
Akron, OH 44304
Phone (330) 375-6350

4466 Fulton Dr NW
Canton, OH 44718
Phone (330) 489-1386

437 Portage Trl
Cuyahoga Fls, OH 44221
Phone (330) 929-9136

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1302998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1962792515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 EMBASSY PKWY STE 300",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443331799",
            "telephone_number": "330-668-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182864",
            "telephone_number": "330-668-4065",
            "fax_number": "330-668-4082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3925 Embassy Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443331799",
            "country_code": "US",
            "telephone_number": "330-668-4065",
            "fax_number": "330-668-4082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRHAIDARI",
        "first_name": "SHAYDA",
        "name_prefix": "Miss",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-17",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "35.128792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.