MEDICARE: SHAISTA RAUF MD

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	2084N0400X	Neurology Physician	A65509	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336227073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAISTA RAUF MD

Provider Business Mailing Address
First Line	:	1805 N CALIFORNIA ST STE 201
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-645-4005
Fax Number	:	209-645-6344

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 201
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-645-4005
Fax Number	:	209-645-6344

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/26/2026

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