Provider Demographics
NPI:1639566367
Name:SHREYA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SHREYA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAPEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-642-9674
Mailing Address - Street 1:2471 ROSSER DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3319
Mailing Address - Country:US
Mailing Address - Phone:951-642-9674
Mailing Address - Fax:888-974-8638
Practice Address - Street 1:2471 ROSSER DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3319
Practice Address - Country:US
Practice Address - Phone:951-642-9674
Practice Address - Fax:888-974-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC521582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty