Provider Demographics
NPI:1720536113
Name:ZAFARI, LEEDAH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LEEDAH
Middle Name:
Last Name:ZAFARI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:STE A200
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4742
Mailing Address - Country:US
Mailing Address - Phone:480-969-0630
Mailing Address - Fax:480-969-4138
Practice Address - Street 1:2945 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7941
Practice Address - Country:US
Practice Address - Phone:480-969-0630
Practice Address - Fax:480-969-4138
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant