Healthcare Provider Details

I. General information

NPI: 1992505853
Provider Name (Legal Business Name): SHANTI TURAE CROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHALLENGER DR
ALAMEDA CA
94501-1037
US

IV. Provider business mailing address

941 SHOREPOINT CT APT F221
ALAMEDA CA
94501-5828
US

V. Phone/Fax

Practice location:
  • Phone: 510-337-7000
  • Fax:
Mailing address:
  • Phone: 707-450-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: