Provider Demographics
NPI:1245331495
Name:KANCHAN, SHAMALA VASANT (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMALA
Middle Name:VASANT
Last Name:KANCHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMALA
Other - Middle Name:VASANT
Other - Last Name:KANCHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13946 TRINITY CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5343
Mailing Address - Country:US
Mailing Address - Phone:408-507-0328
Mailing Address - Fax:
Practice Address - Street 1:13946 TRINITY CT
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5343
Practice Address - Country:US
Practice Address - Phone:408-507-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0518602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry