MEDICARE: BIDYARANI SHAMURAILATPAM

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	235Z00000X	Speech-Language Pathologist	SP 14299	CA

General Provider Information

NPI Number	:	1760923668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIDYARANI SHAMURAILATPAM

Provider Business Mailing Address
First Line	:	1269 W SONYA LN UNIT 101
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-6610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HUTTON CENTRE DR STE 400
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-8762
Country	:	US
Telephone Number	:	714-241-5600
Fax Number	:

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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Directions to “ BIDYARANI SHAMURAILATPAM ” Practice Location

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