Provider Demographics
NPI:1265941769
Name:KIRATA, SHIREEN
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:
Last Name:KIRATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY INSTITUTE OF UROLOGY, DERRY
Mailing Address - Street 2:44 BIRCH STREET
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:603-434-6380
Mailing Address - Fax:603-434-3626
Practice Address - Street 1:LAHEY INSTITUTE OF UROLOGY, DERRY
Practice Address - Street 2:44 BIRCH STREET
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-434-6380
Practice Address - Fax:603-434-3626
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6892363A00000X
363AM0700X
NH1312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical