Provider Demographics
NPI:1649316795
Name:VICHARE, SHILPA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHILPA
Middle Name:
Last Name:VICHARE
Suffix:
Gender:F
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 1:877 W FREMONT AVE
Mailing Address - Street 2:STE G1
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-736-0441
Mailing Address - Fax:408-736-0722
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:STE G1
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-736-0441
Practice Address - Fax:408-736-0722
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA217363A00000X
CA15313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112270100Medicaid
TX8B6520Medicare UPIN