Provider Demographics
NPI:1558803544
Name:SHAHMIRZADI, SEAN PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PAUL
Last Name:SHAHMIRZADI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ROBLE AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4831
Mailing Address - Country:US
Mailing Address - Phone:818-264-6111
Mailing Address - Fax:
Practice Address - Street 1:500 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4345
Practice Address - Country:US
Practice Address - Phone:408-551-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer