Provider Demographics
NPI:1558963660
Name:DEOL, SHIVJOT KAUR (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIVJOT
Middle Name:KAUR
Last Name:DEOL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SUNCAST LN STE 5
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9664
Mailing Address - Country:US
Mailing Address - Phone:916-939-3889
Mailing Address - Fax:
Practice Address - Street 1:1200 SUNCAST LN STE 5
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9664
Practice Address - Country:US
Practice Address - Phone:916-939-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program