Healthcare Provider Details

I. General information

NPI: 1245562594
Provider Name (Legal Business Name): PALLABI SANYAL-DEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PALLABI SANYAL M.D.

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/26/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 S SIDEWINDER DRIVE UNIT 114
PARK CITY UT
84060
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 307-840-9834
  • Fax:
Mailing address:
  • Phone: 510-350-2732
  • Fax: 510-879-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA110871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0071496
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: