Provider Demographics
NPI:1386200806
Name:PIRZADA, SHAISTA
Entity Type:Individual
Prefix:
First Name:SHAISTA
Middle Name:
Last Name:PIRZADA
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 1:904 AVENUE E NW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1742
Mailing Address - Country:US
Mailing Address - Phone:571-225-3331
Mailing Address - Fax:
Practice Address - Street 1:6982 MAJESTIC PALM DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-8627
Practice Address - Country:US
Practice Address - Phone:571-225-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8343-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical