Healthcare Provider Details

I. General information

NPI: 1881016475
Provider Name (Legal Business Name): SHAHDI VAKILI F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BLACKHAWK PLAZA CIR
DANVILLE CA
94506-4623
US

IV. Provider business mailing address

3600 BLACKHAWK PLAZA CIR
DANVILLE CA
94506-4623
US

V. Phone/Fax

Practice location:
  • Phone: 925-736-5757
  • Fax:
Mailing address:
  • Phone: 925-736-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: