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NPI Code Detail

MEDICARE: DR. ANISH SUNDERRAJAN SHAH M.D

MEDICARE: DR. ANISH SUNDERRAJAN SHAH M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA84992CA

General Provider Information

NPI Number : 1164615589
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANISH SUNDERRAJAN SHAH M.D
Provider Business Mailing Address
First Line : 480 TESCONI CIR STE B
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4691
Country : US
Telephone Number : 707-206-7268
Fax Number : 707-206-7254
Provider Business Practice Location Address
First Line : 480 TESCONI CIR STE B
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4691
Country : US
Telephone Number : 707-206-7268
Fax Number : 707-206-7254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 02/08/2018

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