Provider Demographics
NPI:1255837076
Name:SHAI, IRA EDEN (MA MS)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:EDEN
Last Name:SHAI
Suffix:
Gender:F
Credentials:MA MS
Other - Prefix:
Other - First Name:IRYNA
Other - Middle Name:
Other - Last Name:ZIERDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9800 SHELARD PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6527
Mailing Address - Country:US
Mailing Address - Phone:651-231-2665
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 335
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1775
Practice Address - Country:US
Practice Address - Phone:651-231-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health