Provider Demographics
NPI:1942650767
Name:SHEKARI, NESSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NESSA
Middle Name:
Last Name:SHEKARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 LOCUST ST APT 405
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5631
Mailing Address - Country:US
Mailing Address - Phone:484-241-5939
Mailing Address - Fax:
Practice Address - Street 1:2501 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3207
Practice Address - Country:US
Practice Address - Phone:215-227-0300
Practice Address - Fax:215-227-0302
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0410901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103314125-0001Medicaid