Basic Information
Provider Information | |||||||||
NPI: | 1124120761 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEJAD | ||||||||
FirstName: | SHAMIM | ||||||||
MiddleName: | HASHEMI | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3600 LIND AVE SW | ||||||||
Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 980574970 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256902715 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4445 TALBOT RD S | ||||||||
Address2: |   | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 980556219 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256903414 | ||||||||
FaxNumber: | 4256909414 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/03/2006 | ||||||||
LastUpdateDate: | 06/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MD00047157 | WA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | MD00047157 | WA | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084A0401X | MD00047157 | WA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084B0040X | MD00047157 | WA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 2084P0015X | MD00047157 | WA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychosomatic Medicine | 2084P0301X | MD00047157 | WA | N |   |   |   |   |
No ID Information.