Provider Demographics
NPI:1942457999
Name:DIWAN, SHILPA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:DIWAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VENTURE STE 350
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7350
Mailing Address - Country:US
Mailing Address - Phone:949-304-6727
Mailing Address - Fax:
Practice Address - Street 1:19772 MACARTHUR BLVD STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2405
Practice Address - Country:US
Practice Address - Phone:949-304-6727
Practice Address - Fax:949-312-5638
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1343482084P0800X, 2084P0805X
IL036-120-3032084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry