MEDICARE: MALATHI SHANMUGAM 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	207Q00000X	Family Medicine Physician	255306	NY
2	207Q00000X	Family Medicine Physician	C139910	CA

General Provider Information

NPI Number	:	1356509608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALATHI SHANMUGAM MD

Provider Business Mailing Address
First Line	:	8120 TIMBERLAKE WAY STE 108
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5413
Country	:	US
Telephone Number	:	212-300-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 TIMBERLAKE WAY STE 108
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5413
Country	:	US
Telephone Number	:	916-252-5000
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	11/14/2020

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Directions to “ MALATHI SHANMUGAM MD” Practice Location

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