Provider Demographics
NPI:1891569273
Name:HEINDL, SHANTI MARIE
Entity Type:Individual
Prefix:
First Name:SHANTI
Middle Name:MARIE
Last Name:HEINDL
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 1:2836 MCCARRAN LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-9375
Mailing Address - Country:US
Mailing Address - Phone:916-300-4042
Mailing Address - Fax:
Practice Address - Street 1:1000 SUNSET BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5482
Practice Address - Country:US
Practice Address - Phone:916-300-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-OAHQNF175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist