Basic Information
| Provider Information | |||||||||
| NPI: | 1003861139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INAMDAR | ||||||||
| FirstName: | SHASHITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D, DABPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601422 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921601422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584275060 | ||||||||
| FaxNumber: | 6193836701 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 EXECUTIVE DR STE 115 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921213022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584275060 | ||||||||
| FaxNumber: | 6193836701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | A102089 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | A102089 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.