Healthcare Provider Details

I. General information

NPI: 1467135442
Provider Name (Legal Business Name): RACHEL SHANA SARRAFZADEH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 1ST AVE APT 4C
NEW YORK NY
10075-1372
US

IV. Provider business mailing address

1502 1ST AVE APT 4C
NEW YORK NY
10075-1372
US

V. Phone/Fax

Practice location:
  • Phone: 818-404-2660
  • Fax:
Mailing address:
  • Phone: 818-404-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: