Provider Demographics
NPI:1922216159
Name:FULLER, SHAHLA NMN (RN, MSN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:SHAHLA
Middle Name:NMN
Last Name:FULLER
Suffix:
Gender:F
Credentials:RN, MSN, CNS
Other - Prefix:MISS
Other - First Name:SHAHLA
Other - Middle Name:NMN
Other - Last Name:SAFAEEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2698 WAVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2436
Mailing Address - Country:US
Mailing Address - Phone:650-326-4344
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse