Basic Information
| Provider Information | |||||||||
| NPI: | 1902220809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHASHITA INAMDAR MD PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601422 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921601422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193836700 | ||||||||
| FaxNumber: | 6193836701 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 EXECUTIVE DR | ||||||||
| Address2: | STE 115 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921213021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584275060 | ||||||||
| FaxNumber: | 6193836701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEATHERFORD | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
| AuthorizedOfficialMiddleName: | ROBIN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6193836700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.