Provider Demographics
NPI:1811190689
Name:SINA, SHAIDA ZAHRA (NMD)
Entity Type:Individual
Prefix:DR
First Name:SHAIDA
Middle Name:ZAHRA
Last Name:SINA
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-5536
Mailing Address - Country:US
Mailing Address - Phone:928-649-0269
Mailing Address - Fax:866-644-6363
Practice Address - Street 1:2530 W STATE RT 89A
Practice Address - Street 2:SUITE B1
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86336-5536
Practice Address - Country:US
Practice Address - Phone:928-451-5416
Practice Address - Fax:866-644-6363
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01-647175F00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No175F00000XOther Service ProvidersNaturopath