=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285737825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEH SHAHEEDY DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 06/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19963 VENTURA BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-703-0234
-----------------------------------------------------
Fax | 818-703-0029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19963 VENTURA BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-703-0234
-----------------------------------------------------
Fax | 818-703-0029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 42416
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------