Provider Demographics
NPI:1831451863
Name:OSTADSHARIF, CODY (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CODY
Middle Name:
Last Name:OSTADSHARIF
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MILLICH DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0550
Mailing Address - Country:US
Mailing Address - Phone:925-787-8793
Mailing Address - Fax:
Practice Address - Street 1:595 MILLICH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0550
Practice Address - Country:US
Practice Address - Phone:925-787-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist