Provider Demographics
NPI:1134533953
Name:SHAHANI, DENA (OD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:SHAHANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2151
Mailing Address - Country:US
Mailing Address - Phone:651-808-0247
Mailing Address - Fax:
Practice Address - Street 1:1284 AUTO PARK WAY STE C
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2222
Practice Address - Country:US
Practice Address - Phone:760-745-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009530152W00000X
AZOPT-002618152W00000X
COOPT.0003895152W00000X
MDNA2937152W00000X
CA14956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist