Healthcare Provider Details

I. General information

NPI: 1225216674
Provider Name (Legal Business Name): SHARAREH DERAKHSHANDEH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARAREH GHAHREMANI

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SAMARITAN DR STE 203
SAN JOSE CA
95124-3910
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 408-523-3870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: