Provider Demographics
NPI:1710279625
Name:SHODHAN, SHIVANI (MD, MPH)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:SHODHAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22336 KESWICK ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5502
Mailing Address - Country:US
Mailing Address - Phone:804-852-7100
Mailing Address - Fax:
Practice Address - Street 1:22336 KESWICK ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5502
Practice Address - Country:US
Practice Address - Phone:804-852-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58731207RI0011X
NMMD2023-0545207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology