Provider Demographics
NPI:1083622138
Name:SHAH, SHEFALI (MD)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:SHAH
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 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3400
Practice Address - Fax:916-733-5940
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2506548OtherUNITED HEALTHCARE
CA108698OtherHEALTH NET
CA4749332OtherCIGNA
CAA89282OtherBLUE CROSS
CA90144717OtherPACIFICARE
CA000810659543OtherPHCS
CA1838807OtherGREAT WEST
CAMCMG383900OtherWESTERN HEALTH ADVANTAGE
CA248466OtherINTERPLAN
CA5594383OtherFIRST HEALTH
CA7281628OtherAETNA
CA00A892820Medicare ID - Type Unspecified
CA2506548OtherUNITED HEALTHCARE