Healthcare Provider Details

I. General information

NPI: 1972643286
Provider Name (Legal Business Name): STANLEY SHATSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR STE D
SAN JOSE CA
95124-4006
US

IV. Provider business mailing address

PO BOX 3417
LOS ALTOS CA
94024
US

V. Phone/Fax

Practice location:
  • Phone: 408-780-4745
  • Fax: 408-709-2011
Mailing address:
  • Phone: 408-297-1191
  • Fax: 408-370-9099

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:
Title or Position:
Credential:
Phone: