Provider Demographics
NPI:1063067197
Name:ZHDAMIROV, ANNA (AUD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ZHDAMIROV
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ZHDAMIROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:1234 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3911
Practice Address - Country:US
Practice Address - Phone:415-921-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8342237600000X
CARPE12701231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter