Healthcare Provider Details

I. General information

NPI: 1003861139
Provider Name (Legal Business Name): SHASHITA INAMDAR M.D., PH.D, DABPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 SHOREHAM PL STE 100
SAN DIEGO CA
92122-5904
US

IV. Provider business mailing address

5060 SHOREHAM PL STE 100
SAN DIEGO CA
92122-5904
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-0344
  • Fax: 858-248-4262
Mailing address:
  • Phone: 858-221-0344
  • Fax: 858-248-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA102089
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA102089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: