Provider Demographics
NPI:1487262275
Name:MADGEDI, SHEILA N/A (NP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:N/A
Last Name:MADGEDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 GENESEE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4965
Mailing Address - Country:US
Mailing Address - Phone:619-447-2425
Mailing Address - Fax:
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4946
Practice Address - Country:US
Practice Address - Phone:619-447-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA660658163WP1700X
CA95015221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP1700XNursing Service ProvidersRegistered NursePerinatal