MEDICARE: MS. ELHAM SHAYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174832364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELHAM SHAYAN

Provider Business Mailing Address
First Line	:	213 N PALM DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4917
Country	:	US
Telephone Number	:	310-666-7974
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 N PALM DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4917
Country	:	US
Telephone Number	:	310-666-7974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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