MEDICARE: DR. SHANIAH PEREIDA DPM

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
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1235060435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANIAH PEREIDA DPM

Provider Business Mailing Address
First Line	:	3801 MIRANDA AVE
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1290
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 MIRANDA AVE
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1207
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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