Provider Demographics
NPI:1073788360
Name:UPADHYAY, SHIVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:UPADHYAY
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:PO BOX 512717
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0717
Mailing Address - Country:US
Mailing Address - Phone:310-423-4423
Mailing Address - Fax:310-423-1141
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:805-879-4844
Practice Address - Fax:805-879-4266
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111701208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics