Healthcare Provider Details

I. General information

NPI: 1124833389
Provider Name (Legal Business Name): SANDHYA SHALINI PRASAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY
CHERRYLAND CA
94541-1948
US

IV. Provider business mailing address

26337 HUNTWOOD AVE
HAYWARD CA
94544-3302
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-7676
  • Fax:
Mailing address:
  • Phone: 510-552-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95348449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: