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General NPI Number Information
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NPI Number | 1033487145
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Entity Type | Individual
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Provider Name | SHUBHANGI B DESHMUKH PA
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Gender | Female
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Dates
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Enumeration Date | 12/03/2011
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 2725 MYRTLE AVE
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City | EUREKA
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State | CA
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Zip | 95501-3425
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Country | US
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Telephone | 800-453-3030
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Fax | 800-328-3091
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Provider Business Mailing Address
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Address Line | 2725 MYRTLE AVE
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City | EUREKA
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State | CA
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Zip | 95501-3425
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Country | US
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Telephone | 800-453-3030
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Fax | 800-328-3091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601006151
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 60530735
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23143
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License Number State | CA
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