Provider Demographics
NPI:1720110539
Name:RAGHAVAN, SHARADHA (MD)
Entity Type:Individual
Prefix:
First Name:SHARADHA
Middle Name:
Last Name:RAGHAVAN
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 1:841 BLOSSOM HILL RD
Mailing Address - Street 2:#207
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-629-3997
Mailing Address - Fax:408-629-3580
Practice Address - Street 1:841 BLOSSOM HILL RD
Practice Address - Street 2:#207
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-629-3997
Practice Address - Fax:408-629-3580
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA478562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR2313601OtherDEA
CABR2313601OtherDEA
CA00A478560Medicare ID - Type Unspecified