Provider Demographics
NPI:1457944076
Name:REZAIE, SHAGHAYEGH (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SHAGHAYEGH
Middle Name:
Last Name:REZAIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9303
Mailing Address - Country:US
Mailing Address - Phone:142-645-8525
Mailing Address - Fax:214-648-9533
Practice Address - Street 1:6201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9201
Practice Address - Country:US
Practice Address - Phone:214-645-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7915162085R0001X
TX1021649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology