Provider Demographics
NPI:1619980398
Name:SHIRZAD, JAHEDA (PA)
Entity Type:Individual
Prefix:
First Name:JAHEDA
Middle Name:
Last Name:SHIRZAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7426 W BONNIE PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1124
Mailing Address - Country:US
Mailing Address - Phone:509-783-5059
Mailing Address - Fax:509-736-1168
Practice Address - Street 1:7426 W BONNIE PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1124
Practice Address - Country:US
Practice Address - Phone:509-783-5059
Practice Address - Fax:509-736-1168
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8386898Medicaid