Healthcare Provider Details

I. General information

NPI: 1164734224
Provider Name (Legal Business Name): SHABNAM PEYVANDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

34TH & CIVIC CENTER BLVD. CHOP DIVISION OF PEDIATRIC CARDIOLOGY
PHILADELPHIA PA
19104-4399
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone: 215-590-3274
  • Fax: 215-590-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104137
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMT192705
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA104137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: