Provider Demographics
NPI:1215914619
Name:SHAKERI-CEREJO, SHIDROKH (MD)
Entity type:Individual
Prefix:DR
First Name:SHIDROKH
Middle Name:
Last Name:SHAKERI-CEREJO
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 1:1928 UNIVERSITY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-481-4942
Mailing Address - Fax:916-734-6548
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:#3100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-5195
Practice Address - Fax:916-734-6548
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI818122085R0202X
CAA877492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN