Provider Demographics
NPI:1871237644
Name:COOPERMAN, SHAYNA PORTANOVA (MD)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:PORTANOVA
Last Name:COOPERMAN
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 1:801 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1611
Mailing Address - Country:US
Mailing Address - Phone:650-725-6500
Mailing Address - Fax:650-725-8502
Practice Address - Street 1:801 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1611
Practice Address - Country:US
Practice Address - Phone:650-725-6500
Practice Address - Fax:650-725-8502
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program