Provider Demographics
NPI:1487973798
Name:RAISONI, SNEHAL (MD)
Entity type:Individual
Prefix:
First Name:SNEHAL
Middle Name:
Last Name:RAISONI
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:PO BOX 0247
Mailing Address - Street 2:HIGHWAY 162 AND BIGGAR LANE
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0247
Mailing Address - Country:US
Mailing Address - Phone:707-983-6181
Mailing Address - Fax:707-983-6802
Practice Address - Street 1:HIWGHWAY 162 AND BIGGAR LANE
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428-0247
Practice Address - Country:US
Practice Address - Phone:707-983-6181
Practice Address - Fax:707-983-6802
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63206-20207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487973798OtherNPI
CA1669532750OtherNPI
CA1114136066OtherNPI
FR5254115OtherDEA