Provider Demographics
NPI:1427201912
Name:SHAKERIFAR, SHAHBANOO SHERY
Entity type:Individual
Prefix:
First Name:SHAHBANOO
Middle Name:SHERY
Last Name:SHAKERIFAR
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 1:7156 ARROYO GRANDE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2257
Mailing Address - Country:US
Mailing Address - Phone:858-484-4519
Mailing Address - Fax:
Practice Address - Street 1:7156 ARROYO GRANDE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2257
Practice Address - Country:US
Practice Address - Phone:858-484-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 170719164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse