Provider Demographics
NPI:1346606589
Name:BANSAL, SHELLY
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:BANSAL
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 1:2151 OAKLAND RD
Mailing Address - Street 2:SPC #506
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1564
Mailing Address - Country:US
Mailing Address - Phone:408-806-3029
Mailing Address - Fax:
Practice Address - Street 1:2151 OAKLAND RD
Practice Address - Street 2:SPC #506
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1564
Practice Address - Country:US
Practice Address - Phone:408-806-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst