Healthcare Provider Details

I. General information

NPI: 1780888107
Provider Name (Legal Business Name): STANLEY A. SHATSKY, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR STE D
SAN JOSE CA
95124-4104
US

IV. Provider business mailing address

PO BOX 3147
LOS ALTOS CA
94024-0147
US

V. Phone/Fax

Practice location:
  • Phone: 408-780-4745
  • Fax: 408-709-2011
Mailing address:
  • Phone: 408-780-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG41499
License Number StateCA

VIII. Authorized Official

Name: MARK BAKER
Title or Position: MANAGER
Credential:
Phone: 408-780-4745