Healthcare Provider Details

I. General information

NPI: 1952255630
Provider Name (Legal Business Name): SHRUTI SHANTARAM KAMATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14755 GREENLEAF ST
SHERMAN OAKS CA
91403-4127
US

IV. Provider business mailing address

1430 W 27TH ST
LOS ANGELES CA
90007-2136
US

V. Phone/Fax

Practice location:
  • Phone: 818-784-8283
  • Fax:
Mailing address:
  • Phone: 213-709-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number28240
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: