Provider Demographics
NPI:1417721069
Name:PISHEH, SHEIDA
Entity Type:Individual
Prefix:
First Name:SHEIDA
Middle Name:
Last Name:PISHEH
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 1:8624 E CHAMA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2802
Mailing Address - Country:US
Mailing Address - Phone:310-621-8242
Mailing Address - Fax:
Practice Address - Street 1:18291 N PIMA RD STE 110-326
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5697
Practice Address - Country:US
Practice Address - Phone:310-621-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ476266225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics