Provider Demographics
NPI:1467898437
Name:DSOUZA, SHANTHI JANUVIW
Entity Type:Individual
Prefix:MS
First Name:SHANTHI
Middle Name:JANUVIW
Last Name:DSOUZA
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 1:3535 BARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-4716
Mailing Address - Country:US
Mailing Address - Phone:530-365-3481
Mailing Address - Fax:
Practice Address - Street 1:3535 BARKWOOD DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-4716
Practice Address - Country:US
Practice Address - Phone:530-365-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711980163W00000X
CA23145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily