Healthcare Provider Details

I. General information

NPI: 1780251132
Provider Name (Legal Business Name): SHAHRZAD SHADMANI PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27201 PUERTA REAL STE 300
MISSION VIEJO CA
92691-8590
US

IV. Provider business mailing address

27201 PUERTA REAL STE 300
MISSION VIEJO CA
92691-8590
US

V. Phone/Fax

Practice location:
  • Phone: 949-259-5123
  • Fax: 949-288-0358
Mailing address:
  • Phone: 949-259-5123
  • Fax: 949-288-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017433
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10009513
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61599694
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000874-NP
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017433
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000874-NP
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10009513
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61599694
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: