Provider Demographics
NPI:1144914938
Name:BAYAT, SHIVA
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:BAYAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18504 MAYALL ST UNIT I
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1420
Mailing Address - Country:US
Mailing Address - Phone:818-746-0474
Mailing Address - Fax:
Practice Address - Street 1:18504 MAYALL ST UNIT I
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-1420
Practice Address - Country:US
Practice Address - Phone:818-746-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program