Shantelle Blackburn

NPI 1164192886 · on the registry since 2021

Practice

Address: 645 Wool Creek Dr
San Jose, CA 95112
Phone: (408) 283-6000
Organisation at this address: Children'S Dental Initiative
Franklin-Mckinley School District
Catholic Charities Of Santa Clara County
School Health Clinics Of Santa Clara County
School Health Clinics Of Santa Clara County
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 27

Registry record

Primary taxonomy: 104100000X
104100000X
Also registered as: 101YM0800X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2024-09-03

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California