Provider Demographics
NPI:1497537740
Name:KHODAYARINEJAD, ZOHREH
Entity Type:Individual
Prefix:MISS
First Name:ZOHREH
Middle Name:
Last Name:KHODAYARINEJAD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ARMAN
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE NA
Mailing Address - Street 1:4912 BEAUFORT CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5465
Mailing Address - Country:US
Mailing Address - Phone:540-566-7651
Mailing Address - Fax:
Practice Address - Street 1:4912 BEAUFORT CT
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-5465
Practice Address - Country:US
Practice Address - Phone:540-566-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALOVEDUA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)