Healthcare Provider Details

I. General information

NPI: 1316696743
Provider Name (Legal Business Name): NICOLE DUDANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 W LAS POSITAS BLVD STE 340
PLEASANTON CA
94588-5804
US

IV. Provider business mailing address

5575 W LAS POSITAS BLVD STE 340
PLEASANTON CA
94588-5804
US

V. Phone/Fax

Practice location:
  • Phone: 925-847-9777
  • Fax:
Mailing address:
  • Phone: 925-847-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA197379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: