Healthcare Provider Details

I. General information

NPI: 1962311282
Provider Name (Legal Business Name): SHANTAL ANNE DE SILVA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 E META ST APT 4
VENTURA CA
93001-3181
US

IV. Provider business mailing address

3645 E THOUSAND OAKS BLVD # 1007
WESTLAKE VILLAGE CA
91362-3606
US

V. Phone/Fax

Practice location:
  • Phone: 805-320-2963
  • Fax:
Mailing address:
  • Phone: 805-320-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: