Healthcare Provider Details

I. General information

NPI: 1609523737
Provider Name (Legal Business Name): ABBY SHAKIBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 MT DIABLO BLVD
LAFAYETTE CA
94549-4022
US

IV. Provider business mailing address

4436 ENGLISH ROSE CMN
FREMONT CA
94538-5443
US

V. Phone/Fax

Practice location:
  • Phone: 626-628-4561
  • Fax:
Mailing address:
  • Phone: 626-628-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49537
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: