Provider Demographics
NPI:1891923298
Name:HOFFMAN, SHIRLEY DATU (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:DATU
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:GENE
Other - Last Name:DATU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3315 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3600
Mailing Address - Country:US
Mailing Address - Phone:916-481-0777
Mailing Address - Fax:916-977-1265
Practice Address - Street 1:3315 WATT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3600
Practice Address - Country:US
Practice Address - Phone:916-481-0777
Practice Address - Fax:916-977-1265
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A11626207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program