Provider Demographics
NPI:1801119995
Name:JEYAKUMAR, SHALINI (MPA, RPA-C)
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:JEYAKUMAR
Suffix:
Gender:F
Credentials:MPA, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:STE 180
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-734-8130
Mailing Address - Fax:925-225-9520
Practice Address - Street 1:20400 LAKE CHABOT RD
Practice Address - Street 2:STE 304
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5316
Practice Address - Country:US
Practice Address - Phone:510-537-0700
Practice Address - Fax:510-537-7795
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB205034OtherMEDICARE GROUP ID