Provider Demographics
NPI:1346283967
Name:SHENOY, ANANTH (MD)
Entity Type:Individual
Prefix:
First Name:ANANTH
Middle Name:
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6066
Mailing Address - Country:US
Mailing Address - Phone:925-778-1400
Mailing Address - Fax:925-778-1428
Practice Address - Street 1:3501 LONE TREE WAY; STE. 3
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6066
Practice Address - Country:US
Practice Address - Phone:925-778-1400
Practice Address - Fax:925-778-1428
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist