Provider Demographics
NPI:1891867412
Name:DANESHMAND, SHAHRAM SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:SEAN
Last Name:DANESHMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:DANESHMAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-882-8350
Mailing Address - Fax:858-882-8383
Practice Address - Street 1:9333 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-882-8350
Practice Address - Fax:858-882-8383
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63844207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A638440Medicaid