Provider Demographics
NPI:1588606677
Name:DE PERALTA, SHELLY SACHDEVA (RN, MSN, NP, CS)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:SACHDEVA
Last Name:DE PERALTA
Suffix:
Gender:F
Credentials:RN, MSN, NP, CS
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:SACHDEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22965 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3230
Mailing Address - Country:US
Mailing Address - Phone:818-716-6675
Mailing Address - Fax:818-716-6675
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:(111E)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4288
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500358363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care