Provider Demographics
NPI:1225141245
Name:SHENDE, URMILA A (MD)
Entity Type:Individual
Prefix:DR
First Name:URMILA
Middle Name:A
Last Name:SHENDE
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 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7620
Practice Address - Street 1:255 FARMERS LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4721
Practice Address - Country:US
Practice Address - Phone:707-545-2255
Practice Address - Fax:707-545-0456
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A603910Medicaid
CAGR0061383Medicaid
CAGR0061383Medicaid
G57006Medicare UPIN
CAZZZ42777ZMedicare PIN