Provider Demographics
NPI:1003439514
Name:MAKHIJA, SHILPA MANU
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:MANU
Last Name:MAKHIJA
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 1:25119 VALLEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HAYWARD WELLNESS CENTER
Practice Address - Street 2:664 SOUTHLAND MALL DRIVE
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-5439
Practice Address - Country:US
Practice Address - Phone:510-501-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA847047163W00000X
CA95014823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse