MEDICARE: DR. SHADI AMINOLOLAMA-SHAKERI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3402X	Radiography Radiologic Technologist	A80023	CA

General Provider Information

NPI Number	:	1073599254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHADI AMINOLOLAMA-SHAKERI M.D.

Provider Business Mailing Address
First Line	:	26 SAXTON CT
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2603
Country	:	US
Telephone Number	:	415-377-8341
Fax Number	:	916-734-6548

Provider Business Practice Location Address
First Line	:	4860 Y ST
Second Line	:	SUITE 3100
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2307
Country	:	US
Telephone Number	:	916-734-5195
Fax Number	:	916-734-6548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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