Provider Demographics
NPI:1124463567
Name:ATAII, SHIDEH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHIDEH
Middle Name:
Last Name:ATAII
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 TUSCANY WAY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4669
Mailing Address - Country:US
Mailing Address - Phone:925-370-5601
Mailing Address - Fax:925-370-5251
Practice Address - Street 1:2500 ALHAMBRA AVE
Practice Address - Street 2:CONTRA COSTA REGIONAL MEDICAL CENTER
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3156
Practice Address - Country:US
Practice Address - Phone:925-370-5601
Practice Address - Fax:925-370-5251
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11186183500000X
CA46107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist