Healthcare Provider Details

I. General information

NPI: 1396366878
Provider Name (Legal Business Name): SHALINI NICOLE CHEDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NE 134TH ST STE 105
VANCOUVER WA
98686-3027
US

IV. Provider business mailing address

PO BOX 22009
PORTLAND OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 360-208-9472
  • Fax:
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4509
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: