Provider Demographics
NPI:1073709416
Name:MALLADI, ARUNDATHI SHENOY (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUNDATHI
Middle Name:SHENOY
Last Name:MALLADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARUNDATHI
Other - Middle Name:V
Other - Last Name:SHENOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 BON AIR RD., #150
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939
Mailing Address - Country:US
Mailing Address - Phone:415-464-9604
Mailing Address - Fax:415-464-0171
Practice Address - Street 1:2 BON AIR RD., #150
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939
Practice Address - Country:US
Practice Address - Phone:415-464-9604
Practice Address - Fax:415-464-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104538207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE222OtherBLUE CROSS