Provider Demographics
NPI:1942411426
Name:SHETH, VAISHALI (OTR)
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39720 POTRERO DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5607
Mailing Address - Country:US
Mailing Address - Phone:510-402-8053
Mailing Address - Fax:
Practice Address - Street 1:39720 POTRERO DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5607
Practice Address - Country:US
Practice Address - Phone:510-402-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2182OtherCA BOARD OF OT
CA1051097OtherNBCOT