Provider Demographics
NPI:1770688848
Name:SALPETER, SHELLEY RUTH (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RUTH
Last Name:SALPETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WINWARD WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2499
Mailing Address - Country:US
Mailing Address - Phone:650-288-0600
Mailing Address - Fax:650-685-8043
Practice Address - Street 1:66 BOVET RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3126
Practice Address - Country:US
Practice Address - Phone:650-554-1000
Practice Address - Fax:650-554-1018
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42816207R00000X, 207RH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A428160Medicaid
CAA29637Medicare UPIN
CA00A428160Medicaid