Provider Demographics
NPI:1184414328
Name:KANDA, SHRUTI
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:KANDA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-3962
Mailing Address - Country:US
Mailing Address - Phone:714-829-6482
Mailing Address - Fax:
Practice Address - Street 1:747 COTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-3962
Practice Address - Country:US
Practice Address - Phone:714-829-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program