Provider Demographics
NPI:1902944820
Name:SHIRKE, SWATI MANISH
Entity Type:Individual
Prefix:DR
First Name:SWATI
Middle Name:MANISH
Last Name:SHIRKE
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 1:2317 KEATS LN.
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582
Mailing Address - Country:US
Mailing Address - Phone:510-931-9217
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:2500 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2909
Practice Address - Country:US
Practice Address - Phone:925-776-1142
Practice Address - Fax:925-776-1148
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD54438Medicaid