Provider Demographics
NPI:1093190084
Name:YAZDANI, SAHBA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAHBA
Middle Name:
Last Name:YAZDANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2710
Mailing Address - Country:US
Mailing Address - Phone:972-745-4446
Mailing Address - Fax:972-377-8699
Practice Address - Street 1:670 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2710
Practice Address - Country:US
Practice Address - Phone:972-745-4446
Practice Address - Fax:972-377-8699
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant