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General NPI Number Information
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NPI Number | 1841286960
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Entity Type | Individual
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Provider Name | SAMUDYATHA SHIVALINGAPPA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 582 S SUNNYVALE AVE
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City | SUNNYVALE
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State | CA
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Zip | 94086-6125
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Country | US
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Telephone | 408-524-4116
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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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 | MD23979
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD23979
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A97567
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License Number State | CA
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