Provider Demographics
NPI:1811420003
Name:SHANBHAG, VIVEK VENKATESH (ND)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:VENKATESH
Last Name:SHANBHAG
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5108
Mailing Address - Country:US
Mailing Address - Phone:408-876-0636
Mailing Address - Fax:
Practice Address - Street 1:344 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5108
Practice Address - Country:US
Practice Address - Phone:408-876-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANDF-552175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath