Provider Demographics
NPI:1790591493
Name:HAIDREY, YALDA FARAH
Entity type:Individual
Prefix:
First Name:YALDA
Middle Name:FARAH
Last Name:HAIDREY
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 1:320 E PORTLAND ST APT 405
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1882
Mailing Address - Country:US
Mailing Address - Phone:949-207-8859
Mailing Address - Fax:
Practice Address - Street 1:320 E PORTLAND ST APT 405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1882
Practice Address - Country:US
Practice Address - Phone:949-207-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant