Provider Demographics
NPI:1639771280
Name:SHETTY, NIKITA D
Entity Type:Individual
Prefix:MISS
First Name:NIKITA
Middle Name:D
Last Name:SHETTY
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 1:1061 REDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-1834
Mailing Address - Country:US
Mailing Address - Phone:408-204-8690
Mailing Address - Fax:
Practice Address - Street 1:2600 S EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2382
Practice Address - Country:US
Practice Address - Phone:408-204-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator