Provider Demographics
NPI:1881016475
Name:VAKILI, SHAHDI (FNP)
Entity Type:Individual
Prefix:
First Name:SHAHDI
Middle Name:
Last Name:VAKILI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BLACKHAWK PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4623
Mailing Address - Country:US
Mailing Address - Phone:925-736-5757
Mailing Address - Fax:
Practice Address - Street 1:3600 BLACKHAWK PLAZA CIR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4623
Practice Address - Country:US
Practice Address - Phone:925-736-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily