Provider Demographics
NPI:1215918800
Name:SHENKMAN, HEATHER JOY (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JOY
Last Name:SHENKMAN
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 1:18663 VENTURA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4151
Mailing Address - Country:US
Mailing Address - Phone:818-938-9505
Mailing Address - Fax:818-938-9513
Practice Address - Street 1:18663 VENTURA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-938-9505
Practice Address - Fax:818-938-9513
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98800207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4414759Medicaid
MIH64915Medicare UPIN