Healthcare Provider Details

I. General information

NPI: 1225141245
Provider Name (Legal Business Name): URMILA A. SHENDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 FARMERS LN
SANTA ROSA CA
95405-4721
US

IV. Provider business mailing address

1179 N MCDOWELL BLVD
PETALUMA CA
94954-6559
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-2255
  • Fax: 707-545-0456
Mailing address:
  • Phone: 707-559-7500
  • Fax: 707-559-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA60391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: