Provider Demographics
NPI:1972883072
Name:MADANI, SEPIDEH
Entity Type:Individual
Prefix:MS
First Name:SEPIDEH
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DARRYL DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1826
Mailing Address - Country:US
Mailing Address - Phone:408-690-6161
Mailing Address - Fax:
Practice Address - Street 1:80 DARRYL DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1826
Practice Address - Country:US
Practice Address - Phone:408-690-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2292491Medicare PIN