Provider Demographics
NPI:1104595339
Name:AMADEH, SHEIDA JALILI
Entity type:Individual
Prefix:
First Name:SHEIDA
Middle Name:JALILI
Last Name:AMADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33894 CASSIO CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2016
Mailing Address - Country:US
Mailing Address - Phone:510-648-5218
Mailing Address - Fax:
Practice Address - Street 1:33894 CASSIO CIR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2016
Practice Address - Country:US
Practice Address - Phone:510-648-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist