Provider Demographics
NPI:1205242674
Name:GHAZIZADEH, SHIVA
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:GHAZIZADEH
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 1:1304 W BRANCH HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1144
Mailing Address - Country:US
Mailing Address - Phone:214-606-5491
Mailing Address - Fax:
Practice Address - Street 1:1304 W BRANCH HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1144
Practice Address - Country:US
Practice Address - Phone:214-606-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography