Provider Demographics
NPI:1386104289
Name:SHETH, PUJA DIPAK (MD)
Entity type:Individual
Prefix:
First Name:PUJA
Middle Name:DIPAK
Last Name:SHETH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:PUJA
Other - Middle Name:
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:39350 CIVIC CENTER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39350 CIVIC CENTER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2343
Practice Address - Country:US
Practice Address - Phone:415-476-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1869582084P0800X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine