Provider Demographics
NPI:1164835054
Name:DIANAT, SHOKOUFEH (DO)
Entity Type:Individual
Prefix:
First Name:SHOKOUFEH
Middle Name:
Last Name:DIANAT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2601
Mailing Address - Country:US
Mailing Address - Phone:804-355-4358
Mailing Address - Fax:
Practice Address - Street 1:201 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2601
Practice Address - Country:US
Practice Address - Phone:804-355-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15564207Q00000X, 207Q00000X
VA0102205727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN