Provider Demographics
NPI:1700220159
Name:SHENOY, PREETI
Entity Type:Individual
Prefix:MS
First Name:PREETI
Middle Name:
Last Name:SHENOY
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 1:30 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-7910
Mailing Address - Country:US
Mailing Address - Phone:973-978-6010
Mailing Address - Fax:
Practice Address - Street 1:2809 OLIVE HWY STE 220
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6133
Practice Address - Country:US
Practice Address - Phone:530-532-8161
Practice Address - Fax:530-538-3270
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-28
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164653208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery