Provider Demographics
NPI:1265008429
Name:GHOSH, SHUBHRA
Entity Type:Individual
Prefix:
First Name:SHUBHRA
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 MARINER DR APT C
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3366
Mailing Address - Country:US
Mailing Address - Phone:165-038-2856
Mailing Address - Fax:
Practice Address - Street 1:400 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5106
Practice Address - Country:US
Practice Address - Phone:831-600-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst