Provider Demographics
NPI:1710165774
Name:PARAMANANDAM, SHELLEY DIANE (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DIANE
Last Name:PARAMANANDAM
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:2486 PONDEROSA NORTH
Mailing Address - Street 2:SUITE D 106 DOS CAMINOS PHYSICAL THERAPY AND SPORTS REH
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-484-5447
Mailing Address - Fax:805-484-2158
Practice Address - Street 1:2486 PONDEROSA NORTH
Practice Address - Street 2:SUITE D 106 DOS CAMINOS PHYSICAL THERAPY AND SPORTS REH
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-5447
Practice Address - Fax:805-484-2158
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2018-09-14
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Provider Licenses
StateLicense IDTaxonomies
CAPT16880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist