Healthcare Provider Details

I. General information

NPI: 1952061202
Provider Name (Legal Business Name): TINA SAJADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22722 29TH DR SE STE 100
BOTHELL WA
98021-4420
US

IV. Provider business mailing address

2300 W SAHARA AVE STE 800
LAS VEGAS NV
89102-4397
US

V. Phone/Fax

Practice location:
  • Phone: 877-725-4645
  • Fax:
Mailing address:
  • Phone: 877-725-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number851156
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number851156
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: