Provider Demographics
NPI:1952849408
Name:SHAKYA, SHRIJANA (DDS)
Entity Type:Individual
Prefix:
First Name:SHRIJANA
Middle Name:
Last Name:SHAKYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 SAINT PAUL WAY
Mailing Address - Street 2:APT 202
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1892
Mailing Address - Country:US
Mailing Address - Phone:334-557-9134
Mailing Address - Fax:
Practice Address - Street 1:4232 SAINT PAUL WAY
Practice Address - Street 2:APT 202
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1892
Practice Address - Country:US
Practice Address - Phone:334-557-9134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist