Provider Demographics
NPI:1679680698
Name:SOOD, SHASHI T (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHASHI
Middle Name:T
Last Name:SOOD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:STE 110
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2812
Mailing Address - Country:US
Mailing Address - Phone:209-525-3185
Mailing Address - Fax:209-522-1662
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:STE 110
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2812
Practice Address - Country:US
Practice Address - Phone:209-525-3185
Practice Address - Fax:209-522-1662
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-03-23
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Provider Licenses
StateLicense IDTaxonomies
CA838105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28537Medicare UPIN
CA00A381050Medicare ID - Type Unspecified