Healthcare Provider Details

I. General information

NPI: 1770688848
Provider Name (Legal Business Name): SHELLEY RUTH SALPETER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S NORFOLK ST STE 350
SAN MATEO CA
94403-1171
US

IV. Provider business mailing address

1900 S NORFOLK ST STE 350
SAN MATEO CA
94403-1171
US

V. Phone/Fax

Practice location:
  • Phone: 650-532-2321
  • Fax: 650-532-2333
Mailing address:
  • Phone: 650-532-2321
  • Fax: 650-532-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA42816
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA42816
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA42816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: