Provider Demographics
NPI:1962650408
Name:SHIRAZI, SHADI GHAFFARIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:GHAFFARIAN
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 210TH CIR NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4210
Mailing Address - Country:US
Mailing Address - Phone:818-635-4337
Mailing Address - Fax:206-397-0047
Practice Address - Street 1:320 NE 97TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-397-0041
Practice Address - Fax:206-397-0042
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60568609103TC0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty