Provider Demographics
NPI:1710324223
Name:SHAFIEIADL, SOGOL (MS)
Entity Type:Individual
Prefix:
First Name:SOGOL
Middle Name:
Last Name:SHAFIEIADL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 GREENFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2138
Mailing Address - Country:US
Mailing Address - Phone:510-541-1926
Mailing Address - Fax:
Practice Address - Street 1:1428 GREENFIELD CIR
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2138
Practice Address - Country:US
Practice Address - Phone:510-541-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist