Healthcare Provider Details

I. General information

NPI: 1538824966
Provider Name (Legal Business Name): SHALYN CALABAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HS 29 ISLETA ST
SN DOMINGO PU NM
87052
US

IV. Provider business mailing address

PO BOX 427
SANTO DOMINGO PUEBLO NM
87052-0427
US

V. Phone/Fax

Practice location:
  • Phone: 505-415-3862
  • Fax:
Mailing address:
  • Phone: 505-465-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: