Provider Demographics
NPI:1396216966
Name:JAMSHIDI, MICHAEL (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:JAMSHIDI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 S JUDD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6350
Mailing Address - Country:US
Mailing Address - Phone:301-741-6315
Mailing Address - Fax:
Practice Address - Street 1:1318 S JUDD ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6350
Practice Address - Country:US
Practice Address - Phone:301-741-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1757175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath