Provider Demographics
NPI:1033384458
Name:AMBARDAR, SHEENIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEENIE
Middle Name:
Last Name:AMBARDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18040 SHERMAN WAY
Mailing Address - Street 2:KAISER PERMANENTE SHERMAN TERRACE MEDICAL OFFICES
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4631
Mailing Address - Country:US
Mailing Address - Phone:818-758-1200
Mailing Address - Fax:
Practice Address - Street 1:18040 SHERMAN WAY
Practice Address - Street 2:KAISER PERMANENTE SHERMAN TERRACE MEDICAL OFFICES
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4631
Practice Address - Country:US
Practice Address - Phone:818-758-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-26
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 1053692084P0800X
NY248089-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry