Provider Demographics
NPI:1548714108
Name:NESHAT, JALEH
Entity type:Individual
Prefix:
First Name:JALEH
Middle Name:
Last Name:NESHAT
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 1:6512 SIX FORKS RD
Mailing Address - Street 2:STE. 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-844-9898
Mailing Address - Fax:919-866-1942
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:STE. 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-844-9898
Practice Address - Fax:919-866-1942
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3082251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26-010-6516OtherEIN