Provider Demographics
NPI:1568083046
Name:PHANSE, SHIVANI (DPM)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:PHANSE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 MIRAMAR RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2641
Mailing Address - Country:US
Mailing Address - Phone:510-371-2359
Mailing Address - Fax:
Practice Address - Street 1:2345 E 8TH ST STE 105
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2866
Practice Address - Country:US
Practice Address - Phone:510-371-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6018213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery