Provider Demographics
NPI:1710650486
Name:SHOURIJEH, LADAN JAFARI
Entity Type:Individual
Prefix:
First Name:LADAN
Middle Name:JAFARI
Last Name:SHOURIJEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19601 GALWAY BAY CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-4602
Mailing Address - Country:US
Mailing Address - Phone:301-275-8996
Mailing Address - Fax:
Practice Address - Street 1:4201 CATHEDRAL AVE NW APT 516
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4901
Practice Address - Country:US
Practice Address - Phone:301-275-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide