Provider Demographics
NPI:1023900834
Name:SOHAL, SHUBHPREET KAUR
Entity type:Individual
Prefix:
First Name:SHUBHPREET
Middle Name:KAUR
Last Name:SOHAL
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 1:1853 KEPPEL WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7213
Mailing Address - Country:US
Mailing Address - Phone:530-712-5497
Mailing Address - Fax:
Practice Address - Street 1:1853 KEPPEL WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7213
Practice Address - Country:US
Practice Address - Phone:530-712-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily