Provider Demographics
NPI:1861529943
Name:BAZAZ, SHIRIN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:M
Last Name:BAZAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 SADDLEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3444
Mailing Address - Country:US
Mailing Address - Phone:512-636-1704
Mailing Address - Fax:
Practice Address - Street 1:913 SADDLEBROOK CIR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3444
Practice Address - Country:US
Practice Address - Phone:512-636-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical