Healthcare Provider Details

I. General information

NPI: 1548269723
Provider Name (Legal Business Name): SHIREEN R DAMANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE 113
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

255 W BULLARD AVE 113
CLOVIS CA
93612-0861
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-7819
  • Fax: 559-298-5384
Mailing address:
  • Phone: 559-298-7819
  • Fax: 559-298-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA33529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: