Provider Demographics
NPI:1013639897
Name:PANDEY, SHREE K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SHREE
Middle Name:K
Last Name:PANDEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 FERMI PL STE 105
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-9411
Mailing Address - Country:US
Mailing Address - Phone:530-759-9110
Mailing Address - Fax:
Practice Address - Street 1:4515 FERMI PL STE 105
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-9411
Practice Address - Country:US
Practice Address - Phone:530-759-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA62823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant