Provider Demographics
NPI:1578681532
Name:SHENASI AZARI, SHIRIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:SHENASI AZARI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORPORATE PARK STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5196
Mailing Address - Country:US
Mailing Address - Phone:657-221-9267
Mailing Address - Fax:
Practice Address - Street 1:8 CORPORATE PARK STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5196
Practice Address - Country:US
Practice Address - Phone:657-221-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY24939OtherBOARD OF PSYCHOLOGY