Provider Demographics
NPI:1215440839
Name:SHIRAZI, SHAWNA LILA
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LILA
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 GUNPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3382
Mailing Address - Country:US
Mailing Address - Phone:408-427-2283
Mailing Address - Fax:
Practice Address - Street 1:6654 GUNPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3382
Practice Address - Country:US
Practice Address - Phone:720-773-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
COCSW.099293361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator