Provider Demographics
NPI:1013695964
Name:NIEMEYER, SHALI CAI
Entity Type:Individual
Prefix:DR
First Name:SHALI
Middle Name:CAI
Last Name:NIEMEYER
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 1:89 DEEPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3787
Mailing Address - Country:US
Mailing Address - Phone:415-885-9955
Mailing Address - Fax:
Practice Address - Street 1:91-5431 KAPOLEI PKWY STE 1707
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-5009
Practice Address - Country:US
Practice Address - Phone:808-460-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-30931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice