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General NPI Number Information
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NPI Number | 1780885517
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Entity Type | Individual
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Provider Name | MADHU B SHETTI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 2000 VALE RD DOCTORS MEDICAL CENTER - CANCER CENTER
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City | SAN PABLO
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State | CA
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Zip | 94806-3808
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Country | US
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Telephone | 313-871-9346
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Fax |
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Provider Business Mailing Address
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Address Line | 54 STALYBRIDGE ST
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City | SUGAR LAND
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State | TX
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Zip | 77479-2958
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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 |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301087455
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A114733
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License Number State | CA
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