Healthcare Provider Details

I. General information

NPI: 1669700886
Provider Name (Legal Business Name): SHEHLANOOR A HUSENI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13939 E 14TH ST STE 180
SAN LEANDRO CA
94578-2601
US

IV. Provider business mailing address

13939 E 14TH ST STE 180
SAN LEANDRO CA
94578-2601
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-6805
  • Fax: 510-263-3350
Mailing address:
  • Phone: 510-243-6805
  • Fax: 510-263-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA109237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberA109237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: