Provider Demographics
NPI:1841566007
Name:SHASTRI, VINITA GIDVANI (MD)
Entity Type:Individual
Prefix:
First Name:VINITA
Middle Name:GIDVANI
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VINITA
Other - Middle Name:KISHORE
Other - Last Name:GIDVANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3801 MIRANDA AVE # 182B
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE # 182B
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty