Provider Demographics
NPI:1992505853
Name:CROOM, SHANTI TURAE
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:TURAE
Last Name:CROOM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 SHOREPOINT CT APT F221
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5828
Mailing Address - Country:US
Mailing Address - Phone:707-450-6132
Mailing Address - Fax:
Practice Address - Street 1:2060 CHALLENGER DR
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1037
Practice Address - Country:US
Practice Address - Phone:510-337-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach