Healthcare Provider Details

I. General information

NPI: 1518041805
Provider Name (Legal Business Name): SHETAL DESAI RAUTELA RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHETAL DESAI RD

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR 3RD FLOOR
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

577 AIRPORT BLVD STE 300
BURLINGAME CA
94010-2020
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8515
  • Fax:
Mailing address:
  • Phone: 650-240-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number923049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: