Provider Demographics
NPI:1417509837
Name:DADARI, SHAWYAN
Entity Type:Individual
Prefix:
First Name:SHAWYAN
Middle Name:
Last Name:DADARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 GUADALUPE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1330
Mailing Address - Country:US
Mailing Address - Phone:512-354-3696
Mailing Address - Fax:
Practice Address - Street 1:3701 GUADALUPE ST STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1330
Practice Address - Country:US
Practice Address - Phone:512-354-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist