Healthcare Provider Details

I. General information

NPI: 1003514274
Provider Name (Legal Business Name): SHALVI SHAILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5763
US

IV. Provider business mailing address

280 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5763
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-8452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: