Provider Demographics
NPI:1871689471
Name:SARNEVESHT, NADEREH (PA)
Entity Type:Individual
Prefix:
First Name:NADEREH
Middle Name:
Last Name:SARNEVESHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2063
Mailing Address - Country:US
Mailing Address - Phone:510-841-0411
Mailing Address - Fax:510-845-5030
Practice Address - Street 1:2905 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2063
Practice Address - Country:US
Practice Address - Phone:510-841-0411
Practice Address - Fax:510-845-5030
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA144770Medicaid
CA0PA144770Medicaid
CAS59282Medicare UPIN