Healthcare Provider Details

I. General information

NPI: 1427808369
Provider Name (Legal Business Name): SHERWIN SHABDAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 VIA DEL ORO
SAN JOSE CA
95119-1392
US

IV. Provider business mailing address

1800 HARRISON ST FL 21
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 408-360-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: