Provider Demographics
NPI:1487135455
Name:SHAHPARASTI, AVA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AVA
Middle Name:
Last Name:SHAHPARASTI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17490 MEANDERING WAY APT 1207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6150
Mailing Address - Country:US
Mailing Address - Phone:972-375-1662
Mailing Address - Fax:
Practice Address - Street 1:2460 MARSH LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1612
Practice Address - Country:US
Practice Address - Phone:214-731-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist