Healthcare Provider Details

I. General information

NPI: 1063115798
Provider Name (Legal Business Name): SUSAN SHERALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

V. Phone/Fax

Practice location:
  • Phone: 806-282-4683
  • Fax:
Mailing address:
  • Phone: 806-282-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW5562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: