Healthcare Provider Details

I. General information

NPI: 1588571251
Provider Name (Legal Business Name): SHANJIT SINGH SANDHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 EDENVIEW DR
SAN JOSE CA
95111-4031
US

IV. Provider business mailing address

4202 VICTORIA PARK DR
SAN JOSE CA
95136-2037
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: