Healthcare Provider Details

I. General information

NPI: 1659759512
Provider Name (Legal Business Name): SHALIN PANDYA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 EUREKA RD STE 102
ROSEVILLE CA
95661-3047
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

V. Phone/Fax

Practice location:
  • Phone: 167-366-6449
  • Fax: 916-774-0143
Mailing address:
  • Phone: 916-736-3399
  • Fax: 916-736-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20A16270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: