Provider Demographics
NPI:1538569876
Name:BHAVE, SHRUTI ABHAY
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:ABHAY
Last Name:BHAVE
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 1:105 HEMINGWAY CMN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5423
Mailing Address - Country:US
Mailing Address - Phone:925-408-4239
Mailing Address - Fax:
Practice Address - Street 1:2819 CROW CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1655
Practice Address - Country:US
Practice Address - Phone:925-264-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist