Healthcare Provider Details

I. General information

NPI: 1881309094
Provider Name (Legal Business Name): SHIMA BAYGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 RIVER OAKS PL APT 464
SAN JOSE CA
95134-2081
US

IV. Provider business mailing address

55 RIVER OAKS PL APT 464
SAN JOSE CA
95134-2081
US

V. Phone/Fax

Practice location:
  • Phone: 607-727-1172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: