Shady Borna

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

19929 Issued in CA

Practice address

348 S. Hauser Blvd Apt 102
Los Angeles, CA 90036-3293

Phone

(818) 640-9716

NPI assigned

Nov 1, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shady Borna Nassi Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1497031710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 S. HAUSER BLVD APT 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363293",
            "telephone_number": "818-640-9716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 S. HAUSER BLVD APT 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363293",
            "telephone_number": "818-640-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNA",
        "first_name": "SHADY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "19929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHADY",
            "last_name": "NASSI",
            "middle_name": "BORNA",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Raymond Michael Born
• Borna Solomon MD., Corp
• Farshid Borna, DDS.MS
• Neda Borna
• Reza Mehryar Borna, M.D.
• Zachary Ray Bornholtz, PT, DPT, CSCS
• Danna Bornstein
• Jeffrey T Bornstein, MS, LPCC
• John Bernard Bornstein, M.D.
• Emil Borokhovich

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.