Provider Demographics
NPI:1265273502
Name:VAHEDIFAR, SHADI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHADI
Middle Name:
Last Name:VAHEDIFAR
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 1:300 S BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4808
Mailing Address - Country:US
Mailing Address - Phone:310-742-9413
Mailing Address - Fax:
Practice Address - Street 1:300 S BEVERLY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4808
Practice Address - Country:US
Practice Address - Phone:310-742-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical