Provider Demographics
NPI:1861620072
Name:SHAH, SHEETAL ASHISH (DO)
Entity type:Individual
Prefix:MRS
First Name:SHEETAL
Middle Name:ASHISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHEETAL
Other - Middle Name:PRAVIN
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4165 BLACKHAWK PLAZA CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4691
Mailing Address - Country:US
Mailing Address - Phone:925-736-7070
Mailing Address - Fax:925-736-7075
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4691
Practice Address - Country:US
Practice Address - Phone:925-736-7070
Practice Address - Fax:925-736-7075
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine