Provider Demographics
NPI:1558759050
Name:CHANDRASHEKHAR, SHUBHA
Entity Type:Individual
Prefix:
First Name:SHUBHA
Middle Name:
Last Name:CHANDRASHEKHAR
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 1:39600 FREMONT BLVD # 60-16
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2112
Mailing Address - Country:US
Mailing Address - Phone:213-359-2052
Mailing Address - Fax:
Practice Address - Street 1:39600 FREMONT BLVD # 60-16
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2112
Practice Address - Country:US
Practice Address - Phone:213-359-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist