Basic Information
| Provider Information | |||||||||
| NPI: | 1699783100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES A. HALEY VETERANS ADMINISTRATION HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 BRUCE B DOWNS BLVD | ||||||||
| Address2: | ATTENTION: DR. SHOHREH IRAVANI | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336124745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13000 BRUCE B DOWNS BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336124745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | IRAVANI | ||||||||
| AuthorizedOfficialFirstName: | SHOHREH | ||||||||
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| AuthorizedOfficialTitleorPosition: | STAFF PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8139722000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME67299 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.