Healthcare Provider Details

I. General information

NPI: 1023637261
Provider Name (Legal Business Name): PREYA S SHETH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA178057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: