Provider Demographics
NPI:1487875795
Name:SHAMEL, MASHAL A (MD)
Entity type:Individual
Prefix:
First Name:MASHAL
Middle Name:A
Last Name:SHAMEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MASHAL
Other - Middle Name:A
Other - Last Name:AHMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1103
Mailing Address - Country:US
Mailing Address - Phone:408-972-6175
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1103
Practice Address - Country:US
Practice Address - Phone:408-972-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97897207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487875795Medicaid
CA1487875795Medicaid