Provider Demographics
NPI:1891497517
Name:DELPASSAND, SHADI KASHEFI (FNP)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:KASHEFI
Last Name:DELPASSAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1920
Mailing Address - Country:US
Mailing Address - Phone:714-537-1387
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 601
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1920
Practice Address - Country:US
Practice Address - Phone:714-537-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95024225363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care