Healthcare Provider Details

I. General information

NPI: 1225685225
Provider Name (Legal Business Name): NAHID DASTYAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE
RENO NV
89502-0993
US

IV. Provider business mailing address

4790 LAKESIDE DR
RENO NV
89509-5816
US

V. Phone/Fax

Practice location:
  • Phone: 775-326-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN82590
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number887303
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: