Provider Demographics
NPI:1215397807
Name:KASHANI, SHIRAZ (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHIRAZ
Middle Name:
Last Name:KASHANI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15106 OLDDALE RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1410
Mailing Address - Country:US
Mailing Address - Phone:202-905-7078
Mailing Address - Fax:
Practice Address - Street 1:15106 OLDDALE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1410
Practice Address - Country:US
Practice Address - Phone:202-905-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT100000047174400000X
MD06871174400000X
VA0119003846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist