Provider Demographics
NPI:1558303321
Name:MOSHASHA, NEDA (OD)
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:MOSHASHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CABRILLO HWY N
Mailing Address - Street 2:SUITE J
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1650
Mailing Address - Country:US
Mailing Address - Phone:650-726-3937
Mailing Address - Fax:
Practice Address - Street 1:80 CABRILLO HWY N
Practice Address - Street 2:SUITE J
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1650
Practice Address - Country:US
Practice Address - Phone:650-726-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA060800262152W00000X
CA13921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM703AMedicare PIN