Provider Demographics
NPI:1073704383
Name:SADEGHZAFEH, SHAMSI B
Entity Type:Individual
Prefix:
First Name:SHAMSI
Middle Name:B
Last Name:SADEGHZAFEH
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 1:120 BELLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604
Mailing Address - Country:US
Mailing Address - Phone:540-542-0200
Mailing Address - Fax:540-542-0218
Practice Address - Street 1:120 BELLVIEW AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22604
Practice Address - Country:US
Practice Address - Phone:540-542-0200
Practice Address - Fax:540-542-0218
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1062702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor