Healthcare Provider Details

I. General information

NPI: 1366490914
Provider Name (Legal Business Name): SHALIN R. SANGHVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 RIVERBEND DR SUITE 200
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

3355 RIVERBEND DR SUITE 200
SPRINGFIELD OR
97477-8800
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6478
  • Fax: 541-485-0452
Mailing address:
  • Phone: 541-485-6478
  • Fax: 541-485-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46569
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD27337
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: