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General NPI Number Information
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NPI Number | 1972024701
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Entity Type | Individual
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Provider Name | SHIVALI DAVE PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/01/2017
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 560 S PASEO DOROTEA STE 4A
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1434
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Country | US
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Telephone | 951-297-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 1824 E AZTEC LN
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-1639
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006167
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56713
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License Number State | CA
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