Provider Demographics
NPI:1457564478
Name:MOINZADEH, SASHA NAZ (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SASHA
Middle Name:NAZ
Last Name:MOINZADEH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6877
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0878
Mailing Address - Country:US
Mailing Address - Phone:425-736-8244
Mailing Address - Fax:
Practice Address - Street 1:507 150TH PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5060
Practice Address - Country:US
Practice Address - Phone:425-736-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003778174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist