Provider Demographics
NPI:1033487145
Name:DESHMUKH, SHUBHANGI B (PA)
Entity type:Individual
Prefix:
First Name:SHUBHANGI
Middle Name:B
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3425
Mailing Address - Country:US
Mailing Address - Phone:800-453-3030
Mailing Address - Fax:800-328-3091
Practice Address - Street 1:2725 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3425
Practice Address - Country:US
Practice Address - Phone:800-453-3030
Practice Address - Fax:800-328-3091
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006151363A00000X
WA60530735363A00000X
CA23143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant