Provider Demographics
NPI:1194860460
Name:AWATANI, SHEFALI DWARKANATH (MD)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:DWARKANATH
Last Name:AWATANI
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 1:2638 CRANSTON CT.
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377
Mailing Address - Country:US
Mailing Address - Phone:209-830-7118
Mailing Address - Fax:209-830-7118
Practice Address - Street 1:975 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-3411
Practice Address - Fax:209-368-3121
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI16022Medicare UPIN