Provider Demographics
NPI:1093227159
Name:SHAHBAZY, DARYA
Entity Type:Individual
Prefix:
First Name:DARYA
Middle Name:
Last Name:SHAHBAZY
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 1:203 ULTRA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8339
Mailing Address - Country:US
Mailing Address - Phone:703-477-0930
Mailing Address - Fax:
Practice Address - Street 1:203 ULTRA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8339
Practice Address - Country:US
Practice Address - Phone:703-477-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health