Provider Demographics
NPI:1679238711
Name:RAAFAT, SEBASTIAN JAHANSHAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:JAHANSHAH
Last Name:RAAFAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 FELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5144
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:415-861-0828
Practice Address - Street 1:52 DORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3828
Practice Address - Country:US
Practice Address - Phone:415-861-0828
Practice Address - Fax:415-861-0140
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant