Provider Demographics
NPI:1538607056
Name:SHOMALZADEH, PARVIN (FNP)
Entity type:Individual
Prefix:
First Name:PARVIN
Middle Name:
Last Name:SHOMALZADEH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14770 MEMORIAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5238
Mailing Address - Country:US
Mailing Address - Phone:281-977-8372
Mailing Address - Fax:281-496-3353
Practice Address - Street 1:1036 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3336
Practice Address - Country:US
Practice Address - Phone:979-877-0022
Practice Address - Fax:979-885-3810
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily