Healthcare Provider Details

I. General information

NPI: 1174740021
Provider Name (Legal Business Name): SHEELA PURI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/12/2021
Certification Date: 06/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 CHURCH ST
GILROY CA
95020-4406
US

IV. Provider business mailing address

6114 LA SALLE AVE # 268
OAKLAND CA
94611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 408-359-6700
  • Fax:
Mailing address:
  • Phone: 650-532-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: