Provider Demographics
NPI:1083273478
Name:KAYAL, SHADEN (BDS)
Entity Type:Individual
Prefix:
First Name:SHADEN
Middle Name:
Last Name:KAYAL
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WASHINGTON ST UNIT 1304
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1645
Mailing Address - Country:US
Mailing Address - Phone:857-413-1663
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST.
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program