Provider Demographics
NPI:1235803602
Name:AL MASHTA, SHAHAD
Entity type:Individual
Prefix:
First Name:SHAHAD
Middle Name:
Last Name:AL MASHTA
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 1:20713 RIPTIDE SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7436
Mailing Address - Country:US
Mailing Address - Phone:571-290-8594
Mailing Address - Fax:
Practice Address - Street 1:6468 TRADING SQ
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2277
Practice Address - Country:US
Practice Address - Phone:571-290-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist