Healthcare Provider Details

I. General information

NPI: 1790475762
Provider Name (Legal Business Name): ZORRAIN SHAKEEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 GREAT EGRET WAY
SACRAMENTO CA
95834-1095
US

IV. Provider business mailing address

2931 GREAT EGRET WAY
SACRAMENTO CA
95834-1095
US

V. Phone/Fax

Practice location:
  • Phone: 916-346-7707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number110378
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: