Provider Demographics
NPI:1174832364
Name:SHAYAN, ELHAM
Entity Type:Individual
Prefix:MS
First Name:ELHAM
Middle Name:
Last Name:SHAYAN
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 1:213 N PALM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4917
Mailing Address - Country:US
Mailing Address - Phone:310-666-7974
Mailing Address - Fax:
Practice Address - Street 1:213 N PALM DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4917
Practice Address - Country:US
Practice Address - Phone:310-666-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health