Provider Demographics
NPI:1699340240
Name:HOLLOWAY, SHEIVA
Entity type:Individual
Prefix:
First Name:SHEIVA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEIVA
Other - Middle Name:
Other - Last Name:VADIPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP-BC
Mailing Address - Street 1:2452 W SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1455 S STAPLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5850
Practice Address - Country:US
Practice Address - Phone:480-633-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ202016492363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics