Provider Demographics
NPI:1386709301
Name:MALLADI, SHANTI (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHANTI
Middle Name:
Last Name:MALLADI
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 1:194 FREEDOM CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6267
Mailing Address - Country:US
Mailing Address - Phone:510-432-0114
Mailing Address - Fax:510-651-8485
Practice Address - Street 1:200 BROWN RD
Practice Address - Street 2:204
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7955
Practice Address - Country:US
Practice Address - Phone:510-432-0114
Practice Address - Fax:510-651-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist