Provider Demographics
NPI:1457852253
Name:PAKKHOO, SHEYDA
Entity Type:Individual
Prefix:
First Name:SHEYDA
Middle Name:
Last Name:PAKKHOO
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 1:133 MONTECITO CRESCENT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3417
Mailing Address - Country:US
Mailing Address - Phone:925-818-5325
Mailing Address - Fax:
Practice Address - Street 1:1910 OLYMPIC BLVD
Practice Address - Street 2:SUITE #220
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5071
Practice Address - Country:US
Practice Address - Phone:925-283-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1669651675106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician