Provider Demographics
NPI:1124390885
Name:SHNEEZAI, SHEELA
Entity Type:Individual
Prefix:
First Name:SHEELA
Middle Name:
Last Name:SHNEEZAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27983 SLOAN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384
Mailing Address - Country:US
Mailing Address - Phone:661-775-0818
Mailing Address - Fax:
Practice Address - Street 1:8039 RESEDA BLVD
Practice Address - Street 2:APT 219
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-461-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist