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General NPI Number Information
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NPI Number | 1205353711
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Entity Type | Individual
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Provider Name | KIANA YAZDIFARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 300 STAFFORD ST STE 200
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City | SPRINGFIELD
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State | MA
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Zip | 01104-3581
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Country | US
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Telephone | 516-524-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PERKINS SQ APT 9
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-1708
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Country | US
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Telephone | 15165248308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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