Provider Demographics
NPI:1720674138
Name:SEDGHAZAR, SAHEL
Entity type:Individual
Prefix:
First Name:SAHEL
Middle Name:
Last Name:SEDGHAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 SPRING LAKE DR # A
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6540
Mailing Address - Country:US
Mailing Address - Phone:240-472-1494
Mailing Address - Fax:
Practice Address - Street 1:7540 SPRING LAKE DR # A
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6540
Practice Address - Country:US
Practice Address - Phone:240-472-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007996225700000X
DCMT1231225700000X
MDR01010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist