Provider Demographics
NPI:1225076847
Name:BEHBAHANI, SHOLEH S (PAC)
Entity Type:Individual
Prefix:MS
First Name:SHOLEH
Middle Name:S
Last Name:BEHBAHANI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-7737
Mailing Address - Fax:318-675-5666
Practice Address - Street 1:5033 W HIGHWAY 290 STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6749
Practice Address - Country:US
Practice Address - Phone:512-265-8980
Practice Address - Fax:512-891-1551
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12309363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1591785Medicaid
LA5F600Medicare PIN
LAQ69754Medicare UPIN