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NPI Code Detail

MEDICARE: MS. MICHELLE SHIRAZI PMHNP

MEDICARE: MS. MICHELLE SHIRAZI PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner10035361OR

General Provider Information

NPI Number : 1396554572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE SHIRAZI PMHNP
Provider Business Mailing Address
First Line : 17185 SE VALLEY VIEW RD
Second Line :
City : PORTLAND
State : OR
Zip : 97267-6340
Country : US
Telephone Number : 949-525-7898
Fax Number :
Provider Business Practice Location Address
First Line : 3060 SE HAWTHORNE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4121
Country : US
Telephone Number : 844-966-6777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2025
Last Update Date : 01/02/2025

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