Healthcare Provider Details

I. General information

NPI: 1548983026
Provider Name (Legal Business Name): SHADI SAREBANHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 402
WASHINGTON DC
20015-2055
US

IV. Provider business mailing address

14227 MANIFEST WAY
NORTH POTOMAC MD
20878-4270
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-7000
  • Fax:
Mailing address:
  • Phone: 571-635-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: