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General NPI Number Information
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NPI Number | 1063209237
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Entity Type | Organization
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Legal Business Name | SHIREE FATCH MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1650 LEAD HILL BLVD STE 400
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City | ROSEVILLE
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State | CA
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Zip | 95661-3072
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Country | US
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Telephone | 916-783-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 LEAD HILL BLVD STE 400
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City | ROSEVILLE
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State | CA
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Zip | 95661-3072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHIREE SEGEV FATCH
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Credential | DO
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Telephone | 916-783-0580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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