Healthcare Provider Details

I. General information

NPI: 1932366200
Provider Name (Legal Business Name): SHOMIR BANERJEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 350
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

PO BOX 2522
MONTEREY CA
93942-2522
US

V. Phone/Fax

Practice location:
  • Phone: 831-687-8311
  • Fax: 831-233-3983
Mailing address:
  • Phone: 831-687-8311
  • Fax: 831-233-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA103779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: