Provider Demographics
NPI:1063641017
Name:JATWANI, SHRADDHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRADDHA
Middle Name:
Last Name:JATWANI
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95620-6133
Practice Address - Country:US
Practice Address - Phone:916-844-1592
Practice Address - Fax:916-560-0168
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034936207R00000X
IN01079840A207R00000X, 207RR0500X
PAMD467962207RR0500X
CAC181334207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine