Provider Demographics
NPI:1780816082
Name:POLHEBER, AMELIA SHAMSI (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:SHAMSI
Last Name:POLHEBER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:AMELIA
Other - Middle Name:SHAMSI
Other - Last Name:PIRASTEHFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MSN
Mailing Address - Street 1:4290 POLK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1524
Mailing Address - Country:US
Mailing Address - Phone:619-563-0507
Mailing Address - Fax:619-563-0015
Practice Address - Street 1:4290 POLK AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1524
Practice Address - Country:US
Practice Address - Phone:619-563-0507
Practice Address - Fax:619-563-0015
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily