Provider Demographics
NPI:1235613043
Name:VAFAEI, SHAIDA (MA)
Entity Type:Individual
Prefix:
First Name:SHAIDA
Middle Name:
Last Name:VAFAEI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 GIRARD AVE S APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2048
Mailing Address - Country:US
Mailing Address - Phone:952-484-2211
Mailing Address - Fax:
Practice Address - Street 1:8500 210TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5707
Practice Address - Country:US
Practice Address - Phone:952-484-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNO NPI YET