Provider Demographics
NPI:1366520488
Name:GHANI, SHAREH O (MD)
Entity type:Individual
Prefix:
First Name:SHAREH
Middle Name:O
Last Name:GHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39180 LIBERTY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2586
Mailing Address - Country:US
Mailing Address - Phone:510-451-2000
Mailing Address - Fax:510-451-2000
Practice Address - Street 1:39180 LIBERTY ST STE 205
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2586
Practice Address - Country:US
Practice Address - Phone:510-451-2000
Practice Address - Fax:510-379-9209
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ315832084P0800X
CAC1337692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ790479Medicaid
CAC133769OtherMEDICARE
AZ102443Medicare ID - Type Unspecified