Provider Demographics
NPI:1164235602
Name:AHMADPOUR, SHAGHAYEGH (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHAGHAYEGH
Middle Name:
Last Name:AHMADPOUR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:AHMADPOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:7021 SANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8011
Mailing Address - Country:US
Mailing Address - Phone:614-961-2304
Mailing Address - Fax:
Practice Address - Street 1:122 GRACELAND BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1530
Practice Address - Country:US
Practice Address - Phone:614-556-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily