=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285056481
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEEVA RAJAEI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2014
-----------------------------------------------------
Last Update Date | 01/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 MOWRY AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-797-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 PRESIDENTIAL DR
-----------------------------------------------------
City | HORSHAM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19044-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-620-1950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A130220
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD470337
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------