Healthcare Provider Details

I. General information

NPI: 1467006890
Provider Name (Legal Business Name): SHAYDA SARRAMI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 NE FOURTH PLAIN BLVD STE 134
VANCOUVER WA
98682-5001
US

IV. Provider business mailing address

1710 NE 122ND AVE
PORTLAND OR
97230-1939
US

V. Phone/Fax

Practice location:
  • Phone: 360-768-0936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60974439
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number35500
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD11946
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: