Healthcare Provider Details

I. General information

NPI: 1750343620
Provider Name (Legal Business Name): SHAILESH SHETTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HIGH ST
SELMA CA
93662-3512
US

IV. Provider business mailing address

2001 HIGH ST
SELMA CA
93662-3512
US

V. Phone/Fax

Practice location:
  • Phone: 559-896-0400
  • Fax:
Mailing address:
  • Phone: 559-896-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38913
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC53019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: