Healthcare Provider Details

I. General information

NPI: 1174843916
Provider Name (Legal Business Name): PRIYASHEELTA NAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 WHIPPLE AVENUE SUITE 3
REDWOOD CITY CA
94062
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 650-817-2117
  • Fax: 650-817-2119
Mailing address:
  • Phone: 209-645-4005
  • Fax: 209-645-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA119122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: