Provider Demographics
NPI:1316305642
Name:CHISHTY, SHAHRUKH
Entity type:Individual
Prefix:
First Name:SHAHRUKH
Middle Name:
Last Name:CHISHTY
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 1:470 CHADBOURNE RD STE F
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9620
Mailing Address - Country:US
Mailing Address - Phone:707-557-4560
Mailing Address - Fax:707-557-7909
Practice Address - Street 1:470 CHADBOURNE RD STE F
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9620
Practice Address - Country:US
Practice Address - Phone:707-557-4560
Practice Address - Fax:707-557-7909
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor