Provider Demographics
NPI:1215789938
Name:SHAH, SHILPI VASTUPAL (DMD)
Entity type:Individual
Prefix:DR
First Name:SHILPI
Middle Name:VASTUPAL
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26953 MISSION BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4157
Mailing Address - Country:US
Mailing Address - Phone:510-690-9896
Mailing Address - Fax:510-274-5806
Practice Address - Street 1:26953 MISSION BLVD STE J
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4157
Practice Address - Country:US
Practice Address - Phone:510-690-9896
Practice Address - Fax:510-274-5806
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096881223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice