Individual
SHIVA REZAEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 SW PEACEFUL LN, PORTLAND, OR 97239-1161
(503) 516-9085
Mailing address
2800 SW PEACEFUL LN, PORTLAND, OR 97239-1161
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-342565
AZ
Other
Enumeration date
08/15/2025
Last updated
08/15/2025
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