Healthcare Provider Details

I. General information

NPI: 1992769939
Provider Name (Legal Business Name): SHYAMALI MALLICK SINGHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHYAMALI MALLICK M.D., PHD.

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/19/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR STE 15-1
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR STE 15-1
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-282-3000
  • Fax: 650-963-5071
Mailing address:
  • Phone: 650-282-3000
  • Fax: 650-963-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA79445
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA79445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: