Provider Demographics
NPI:1225083272
Name:SHETH, MANISH V (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:V
Last Name:SHETH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4510 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-427-5060
Mailing Address - Fax:619-383-6701
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:858-427-5060
Practice Address - Fax:619-383-6701
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-04-02
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Provider Licenses
StateLicense IDTaxonomies
SD52952084P0800X
MN466262084P0800X
CAC531022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040121002OtherPRIMEWEST
22037OtherSANFORD HEALTH PLAN
SDHP40279OtherHEALTHPARTNERS
SD241810OtherMIDLANDS CHOICE
SD57108C035OtherWPS TRICARE
ND12200Medicaid
IA1225083272Medicaid
SD370624200OtherDEPT OF LABOR
SD4993237OtherBLUE CROSS
CAC53102OtherCALIFORNIA MEDICAL LICENSE
SD1225083272OtherARAZ/ AMERICA'S PPO
SD412991040284OtherPREFERRED ONE
MN5G434SHOtherCC SYSTEMS/ BLUE PLUS
SD7101604Medicaid
SD5295OtherDAKOTACARE
MN170133900Medicaid
NE46022474352Medicaid
SD5G434SHOtherBLUE PLUS
SD370624200OtherDEPT OF LABOR
SD7101604Medicaid