Individual ProviderSeyed Shahab Jazayeri MoghaddasInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address56 Franklin St, Waterbury, CT 06706-1253(203) 709-8685(502) 322-2241PECOS EnrollmentBased on the most recent information from CMS, provider Seyed Shahab Jazayeri Moghaddas is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1487113551Provider TypeIndividualFull NameJazayeri Moghaddas, Seyed ShahabCredentialMDGenderMaleSole ProprietorYesEnumeration Date3/18/2019Last Updated6/13/2022Contact InformationPractice LocationPractice Address56 Franklin St, Waterbury, CT 06706-1253Phone(203) 709-8685FaxUnlisted FaxMailing LocationMailing Address1711 S 3rd St, Louisville, KY 40208-1917Phone(502) 322-2241FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense69806ConnecticutCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer