NPIMap

Organization Active NPI

Shashita Inamdar MD Professional Corporation

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1902220809
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SHASHITA INAMDAR MD PROFESSIONAL CORPORATION
Practice address
4510 Executive Dr
Ste 115
San Diego, CA 92121-3021
Phone
(858) 427-5060
Fax
(619) 383-6701
NPI assigned
Feb 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Trina Robin Weatherford
Title
Officer
Phone
(619) 383-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

4510 Executive Dr
Ste 115
San Diego, CA 92121-3021

Mailing address

PO Box 601422
San Diego, CA 92160-1422
Phone (619) 383-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200918002182 OR Part B Supplier - Clinic/Group Practice 4082839774 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

2386 Faraday Ave
Ste 111
Carlsbad, CA 92008

5060 Shoreham Pl
Ste 100
San Diego, CA 92122
Phone (858) 221-0344

4510 Executive Dr
Ste 115
San Diego, CA 92121
Phone (858) 427-5060

32605 Temecula Pkwy
Ste 202
Temecula, CA 92592
Phone (844) 467-3867

516 SE Morrison St
Ste 305
Portland, OR 97214
Phone (503) 284-8558

8555 SW Apple Way
Ste 320
Portland, OR 97225
Phone (503) 298-4592

5109 NE 82nd Ave
Ste 215
Vancouver, WA 98662
Phone (832) 840-1604

Practitioners & affiliated clinicians

Practitioners 117

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 117

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1902220809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601422",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921601422",
            "telephone_number": "619-383-6700",
            "fax_number": "619-383-6701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DR",
            "address_2": "STE 115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213021",
            "telephone_number": "858-427-5060",
            "fax_number": "619-383-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASHITA INAMDAR MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-12",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "WEATHERFORD",
        "authorized_official_first_name": "TRINA",
        "authorized_official_middle_name": "ROBIN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "619-383-6700"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.