Provider Demographics
NPI:1396339362
Name:SHARDIL, SHALA (PMHNP)
Entity type:Individual
Prefix:
First Name:SHALA
Middle Name:
Last Name:SHARDIL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26662 CUENCA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6216
Mailing Address - Country:US
Mailing Address - Phone:949-584-6332
Mailing Address - Fax:
Practice Address - Street 1:26662 CUENCA DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6216
Practice Address - Country:US
Practice Address - Phone:949-584-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016978363LP0808X
CA497454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty