Healthcare Provider Details

I. General information

NPI: 1376178319
Provider Name (Legal Business Name): SADDIF B SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 HALYARD DR
WEST SACRAMENTO CA
95691-3412
US

IV. Provider business mailing address

5421 14TH AVE
SACRAMENTO CA
95820-3003
US

V. Phone/Fax

Practice location:
  • Phone: 855-354-2242
  • Fax:
Mailing address:
  • Phone: 916-412-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number33074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: