Healthcare Provider Details

I. General information

NPI: 1497672778
Provider Name (Legal Business Name): DIMYANA H SHONODA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 VERANO RD
IRVINE CA
92617-3108
US

IV. Provider business mailing address

409 VERANO RD
IRVINE CA
92617-3108
US

V. Phone/Fax

Practice location:
  • Phone: 201-844-4677
  • Fax:
Mailing address:
  • Phone: 201-844-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: