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General NPI Number Information
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NPI Number | 1568752483
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Entity Type | Organization
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Legal Business Name | SHAMALA MD PHYSICIAN PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 555 KNOWLES DRIVE SUITE 109
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-370-0200
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Fax | 408-370-0202
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Provider Business Mailing Address
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Address Line | 555 KNOWLES DRIVE SUITE 109
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-370-0200
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Fax | 408-370-0202
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Authorized Official
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Title or Position | M.D.
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Name | DR. SHAMALA MOHANASUNDARAM
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Credential | M.D.
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Telephone | 408-370-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A112811
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License Number State | CA
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