Provider Demographics
NPI:1578009031
Name:BAHRAMI, SHOHREH (FNP)
Entity Type:Individual
Prefix:
First Name:SHOHREH
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 GILLESPIE ST
Mailing Address - Street 2:#109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4839
Mailing Address - Country:US
Mailing Address - Phone:817-917-9550
Mailing Address - Fax:
Practice Address - Street 1:3618 GILLESPIE ST
Practice Address - Street 2:#109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4839
Practice Address - Country:US
Practice Address - Phone:817-917-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily