Healthcare Provider Details

I. General information

NPI: 1801119995
Provider Name (Legal Business Name): SHALINI JEYAKUMAR MPA, RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 LAKE CHABOT RD STE 304
CASTRO VALLEY CA
94546-5316
US

IV. Provider business mailing address

2301 CAMINO RAMON STE 180
SAN RAMON CA
94583-2060
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-0700
  • Fax: 510-537-7795
Mailing address:
  • Phone: 925-734-8130
  • Fax: 925-225-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: