Provider Demographics
NPI:1659779262
Name:SHIVPURI, SMRITI (MPH, PHD)
Entity type:Individual
Prefix:
First Name:SMRITI
Middle Name:
Last Name:SHIVPURI
Suffix:
Gender:F
Credentials:MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 CORSAIR ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7909
Mailing Address - Country:US
Mailing Address - Phone:619-727-9169
Mailing Address - Fax:
Practice Address - Street 1:2180 CORSAIR ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7909
Practice Address - Country:US
Practice Address - Phone:619-727-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical