Provider Demographics
NPI:1861478521
Name:SHAMASUNDARA, PADMINI (MD)
Entity type:Individual
Prefix:DR
First Name:PADMINI
Middle Name:
Last Name:SHAMASUNDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 E LA PALMA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:949-688-7314
Mailing Address - Fax:949-996-3364
Practice Address - Street 1:5475 E LA PALMA AVE STE 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:949-688-7314
Practice Address - Fax:949-996-3364
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA519332084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982782967OtherNPI