Provider Demographics
NPI:1053296863
Name:CHAKKIWALA, SHIREEN
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:
Last Name:CHAKKIWALA
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 1:1804 LOCHSHYRE LOOP
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-9190
Mailing Address - Country:US
Mailing Address - Phone:407-714-7076
Mailing Address - Fax:
Practice Address - Street 1:1804 LOCHSHYRE LOOP
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-9190
Practice Address - Country:US
Practice Address - Phone:407-714-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist