Provider Demographics
NPI:1396185385
Name:SASTIEL, SHIRLEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SASTIEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 LINCOLN WAY
Mailing Address - Street 2:APT.302
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2369
Mailing Address - Country:US
Mailing Address - Phone:818-518-6666
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD
Practice Address - Street 2:STE.300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3512
Practice Address - Country:US
Practice Address - Phone:323-866-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist