Provider Demographics
NPI:1407366008
Name:ISAZADEH-KHAYLANI, SHEYDA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHEYDA
Middle Name:
Last Name:ISAZADEH-KHAYLANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13305 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2844
Mailing Address - Country:US
Mailing Address - Phone:850-234-2242
Mailing Address - Fax:
Practice Address - Street 1:13305 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2844
Practice Address - Country:US
Practice Address - Phone:850-234-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor