Provider Demographics
NPI:1891933644
Name:VADAEI, SAMAN
Entity Type:Individual
Prefix:
First Name:SAMAN
Middle Name:
Last Name:VADAEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16674 SW 134TH TER
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1834
Mailing Address - Country:US
Mailing Address - Phone:503-929-4203
Mailing Address - Fax:
Practice Address - Street 1:16674 SW 134TH TER
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-1834
Practice Address - Country:US
Practice Address - Phone:503-929-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No372600000XNursing Service Related ProvidersAdult Companion