Provider Demographics
NPI:1003861139
Name:INAMDAR, SHASHITA (MD, PHD, DABPN)
Entity Type:Individual
Prefix:DR
First Name:SHASHITA
Middle Name:
Last Name:INAMDAR
Suffix:
Gender:F
Credentials:MD, PHD, DABPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601422
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-1422
Mailing Address - Country:US
Mailing Address - Phone:858-427-5060
Mailing Address - Fax:619-383-6701
Practice Address - Street 1:4510 EXECUTIVE DR STE 115
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3022
Practice Address - Country:US
Practice Address - Phone:858-427-5060
Practice Address - Fax:619-383-6701
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1020892084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72872Medicare UPIN
SDS100291Medicare PIN