Provider Demographics
NPI:1437158706
Name:SHUNMUGHAM, SHERMILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERMILLA
Middle Name:
Last Name:SHUNMUGHAM
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1090
Mailing Address - Country:US
Mailing Address - Phone:209-465-5550
Mailing Address - Fax:209-334-0127
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:STE 2B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-948-4700
Practice Address - Fax:209-948-9535
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081080Medicaid
CA00A807280Medicaid
CA0-545-821-1OtherECFMG
CA0-545-821-1OtherECFMG
H74082Medicare UPIN
CA00A807280Medicare ID - Type Unspecified