Provider Demographics
NPI:1801668595
Name:SHIRVANIAN, GAYANEH (PA-C)
Entity type:Individual
Prefix:
First Name:GAYANEH
Middle Name:
Last Name:SHIRVANIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GAYANEH
Other - Middle Name:
Other - Last Name:SHIRVANIAN NAMAGARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 FAIRVIEW AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7132
Mailing Address - Country:US
Mailing Address - Phone:818-455-5990
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST STE 310
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-561-4533
Practice Address - Fax:818-561-4534
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant