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General NPI Number Information
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NPI Number | 1235803602
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Entity Type | Individual
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Provider Name | SHAHAD AL MASHTA
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 6468 TRADING SQ
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City | HAYMARKET
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State | VA
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Zip | 20169-2277
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Country | US
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Telephone | 571-290-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 20713 RIPTIDE SQ
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City | STERLING
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State | VA
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Zip | 20165-7436
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Country | US
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Telephone | 571-290-8594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401417526
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License Number State | VA
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