Provider Demographics
NPI:1063228377
Name:KASHEF, SHANEL SHIREEN
Entity type:Individual
Prefix:
First Name:SHANEL
Middle Name:SHIREEN
Last Name:KASHEF
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 1:1206 WOODBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2634
Mailing Address - Country:US
Mailing Address - Phone:510-501-4454
Mailing Address - Fax:
Practice Address - Street 1:1206 WOODBOROUGH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-2634
Practice Address - Country:US
Practice Address - Phone:510-501-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist