Provider Demographics
NPI:1225226475
Name:ZANDIAN, MICHELLE S
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:ZANDIAN
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 1:1309 S MARY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3053
Mailing Address - Country:US
Mailing Address - Phone:408-733-0400
Mailing Address - Fax:408-733-4388
Practice Address - Street 1:1309 S MARY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3053
Practice Address - Country:US
Practice Address - Phone:408-733-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1061363A00000X
CAPA 20349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225226475Medicaid
NV1225226475Medicaid