Healthcare Provider Details

I. General information

NPI: 1427698018
Provider Name (Legal Business Name): SHAILENDRA S BAGHEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PARKMOOR AVE STE 115
SAN JOSE CA
95126-3797
US

IV. Provider business mailing address

1400 PARKMOOR AVE STE 115
SAN JOSE CA
95126-3797
US

V. Phone/Fax

Practice location:
  • Phone: 408-971-9822
  • Fax: 408-510-3484
Mailing address:
  • Phone: 408-971-9822
  • Fax: 408-510-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: