Provider Demographics
NPI:1851840235
Name:GOUDARZI, JAMEELA SHERENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:JAMEELA
Middle Name:SHERENE
Last Name:GOUDARZI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 602108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2108
Mailing Address - Country:US
Mailing Address - Phone:843-792-2300
Mailing Address - Fax:
Practice Address - Street 1:30 BEE STREET
Practice Address - Street 2:STE 210
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-8909
Practice Address - Country:US
Practice Address - Phone:843-792-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily