Healthcare Provider Details

I. General information

NPI: 1487262275
Provider Name (Legal Business Name): SHEILA N/A MADGEDI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE
SAN DIEGO CA
92117-4946
US

IV. Provider business mailing address

4282 GENESEE AVE STE 204
SAN DIEGO CA
92117-4965
US

V. Phone/Fax

Practice location:
  • Phone: 619-447-2425
  • Fax:
Mailing address:
  • Phone: 619-447-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number660658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: