Healthcare Provider Details

I. General information

NPI: 1548213705
Provider Name (Legal Business Name): GURVINDER S SHAHEED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W RANCH VIEW DRIVE
ROCKLIN CA
95765
US

IV. Provider business mailing address

3400 DATA DR PHYSICIAN SUPPORT SERVICES
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-409-1400
  • Fax: 916-409-1499
Mailing address:
  • Phone: 916-379-2948
  • Fax: 916-858-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA67842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: