MEDICARE: DR. RANJIT SHENOY 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
1	207P00000X	Emergency Medicine Physician	113851	MO
2	208000000X	Pediatrics Physician	C52509	CA
3	207R00000X	Internal Medicine Physician	C52509	CA

General Provider Information

NPI Number	:	1407828585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANJIT SHENOY M.D.

Provider Business Mailing Address
First Line	:	1913 SUNNY PARK DR
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-9707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 DALE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-0500
Country	:	US
Telephone Number	:	209-522-0146
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	06/10/2013

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