Provider Demographics
NPI:1528435971
Name:SHAKYA, JASMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:SHAKYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 CASA DEL NORTE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2114
Mailing Address - Country:US
Mailing Address - Phone:518-466-4294
Mailing Address - Fax:
Practice Address - Street 1:6230 PASEO DEL NORTE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2568
Practice Address - Country:US
Practice Address - Phone:505-244-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS612681223G0001X
NMDD4809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice