Provider Demographics
NPI:1982129185
Name:SHETH, KHUSHBU
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CALIFORNIA AVE APT 803
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5027
Mailing Address - Country:US
Mailing Address - Phone:201-637-2938
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY STE 2100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1624
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty