Provider Demographics
NPI:1316913866
Name:URSELL, SHANTHA N (MD)
Entity type:Individual
Prefix:DR
First Name:SHANTHA
Middle Name:N
Last Name:URSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 SELBORNE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3618
Mailing Address - Country:US
Mailing Address - Phone:510-482-4312
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:150 MUIR ROAD
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2000
Practice Address - Fax:925-370-4031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 29848207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease