Healthcare Provider Details

I. General information

NPI: 1699691360
Provider Name (Legal Business Name): SHAMILA WATI KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY # 94541
CHERRYLAND CA
94541-1948
US

IV. Provider business mailing address

494 BLOSSOM WAY # 94541
CHERRYLAND CA
94541-1948
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-7676
  • Fax: 510-582-9080
Mailing address:
  • Phone: 510-582-7676
  • Fax: 510-582-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: