Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A104137 | CA |
Y | 2080P0202X | Pediatric Cardiologist | A104137 | CA |
N | 2080P0202X | Pediatric Cardiologist | MT192705 | PA |
NPI | 1164734224 |
---|---|
Provider Name | Shabnam Peyvandi |
First Address | Philadelphia, PA 19104-4399 |
Second Address | San Francisco, CA 94143-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 17/03/2018 |