Healthcare Provider Details

I. General information

NPI: 1073095055
Provider Name (Legal Business Name): SHADDIN TIRHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 BARROW ST
ANCHORAGE AK
99501-3631
US

IV. Provider business mailing address

1406 W 41ST AVE # A
ANCHORAGE AK
99503-6408
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-1315
  • Fax: 907-278-7129
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number156352
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number123456
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: