Provider Demographics
NPI:1033981352
Name:HAKIMZADEH, SHEHERAZADE A (RBT)
Entity Type:Individual
Prefix:
First Name:SHEHERAZADE
Middle Name:A
Last Name:HAKIMZADEH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12086 FORT CAROLINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2688
Mailing Address - Country:US
Mailing Address - Phone:904-415-1609
Mailing Address - Fax:904-485-8298
Practice Address - Street 1:12086 FORT CAROLINE RD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2688
Practice Address - Country:US
Practice Address - Phone:904-415-1609
Practice Address - Fax:904-485-8298
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT062331106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician