Healthcare Provider Details

I. General information

NPI: 1952228462
Provider Name (Legal Business Name): SEJAL SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E VALENCIA MESA DR
FULLERTON CA
92835-3809
US

IV. Provider business mailing address

1533 GRANDVIEW ST
UPLAND CA
91784-8623
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027892
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95177023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: