Provider Demographics
NPI:1790723203
Name:DESHMUKH, SHILPA VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:VIJAY
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2860 N SANTIAGO BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-1722
Mailing Address - Country:US
Mailing Address - Phone:949-645-0000
Mailing Address - Fax:949-645-0003
Practice Address - Street 1:2860 N SANTIAGO BLVD
Practice Address - Street 2:STE 110
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-1722
Practice Address - Country:US
Practice Address - Phone:949-645-0000
Practice Address - Fax:949-645-0003
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24532Medicare UPIN
CAWA90654AMedicare ID - Type Unspecified