Provider Demographics
NPI: | 1205221843 |
---|---|
Name: | HOLDEN, SMITA SHYAM (MD) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | SMITA |
Middle Name: | SHYAM |
Last Name: | HOLDEN |
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: | 325 DISTEL CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ALTOS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94022-1408 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-600-5760 |
Mailing Address - Fax: | 415-369-1208 |
Practice Address - Street 1: | 1100 VAN NESS AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94109-6978 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-600-5760 |
Practice Address - Fax: | 415-369-1208 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-03-31 |
Last Update Date: | 2022-09-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD462583 | 2084N0400X |
390200000X | ||
CA | A173202 | 2084V0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084V0102X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |