Healthcare Provider Details

I. General information

NPI: 1578487203
Provider Name (Legal Business Name): SHALISA ETI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 KIFER RD
SANTA CLARA CA
95051-0708
US

IV. Provider business mailing address

163 SWEETBERRY CT
SAN JOSE CA
95136-2429
US

V. Phone/Fax

Practice location:
  • Phone: 408-730-6905
  • Fax:
Mailing address:
  • Phone: 408-564-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: