Provider Demographics
NPI:1356407001
Name:KERI, SHIRA AMITAI (MD)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:AMITAI
Last Name:KERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8677 VILLA LA JOLLA DR # 205
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2354
Mailing Address - Country:US
Mailing Address - Phone:858-337-4469
Mailing Address - Fax:858-777-5555
Practice Address - Street 1:2180 GARNET AVE STE 2E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3675
Practice Address - Country:US
Practice Address - Phone:858-337-4469
Practice Address - Fax:858-777-5555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA724662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry