Provider Demographics
NPI:1174835433
Name:JAMPANI, SHANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTI
Middle Name:
Last Name:JAMPANI
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 1:1731 E ROSEVILLE PKWY STE 290
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6453
Mailing Address - Country:US
Mailing Address - Phone:844-867-8444
Mailing Address - Fax:916-836-3977
Practice Address - Street 1:1731 E ROSEVILLE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6453
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:916-836-3977
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180101712084P0800X
FLME1181922084P0804X
390200000X
CAC1863682084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program