Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1225285034 Individual Practitioner Female Practitioner

Dr. Shandi Joycelyn Fuller , MD

Pediatrics • Berkeley, CA

Professional Overview & Biography Verified Profile Summary

Dr. Shandi Fuller, MD is a registered healthcare professional specializing in Pediatrics in Berkeley, CA. Practice services are available at 1918 BONITA AVE STE 200 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1918 Bonita Ave Ste 200

Berkeley, CA 947041014

Telephone 5109391300
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Berkeley, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 31.3 Yrs
State Avg: 22.5 Yrs
Regional Practice Density
55 Specialists

Practicing in Berkeley, CA (9612 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-06-14
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License CA A117119

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Certification
97347 (NC)
Commercial Insurance / Payer ID License
A117119 (CA)

Secondary Practice Locations

2201 Courage Dr

Fairfield, CA 945336733

Phone: 7077848348

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners
Heather Roselaren , LCSW, MPH

Social Worker - Clinical

NPI 1184662603

Licensed Clinical Social Worker, Master of Public Health

Alexandra Sideroff , LMFT, LMHC

Marriage & Family Therapist

NPI 1356599831

Licensed Marriage and Family Therapist, Licensed Mental Health Counselor

Dr. Rachel Crothers , MD

Psychiatry & Neurology - Psychiatry

NPI 1376848705

Doctor of Medicine (M.D.)

Jessica Goodman

Social Worker - Clinical

NPI 1487198651
NPI 1487366506

Doctor of Philosophy (Ph.D.)

NPI 1578770996

Doctor of Psychology (Psy.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location June 14, 2022

Registered at 1918 BONITA AVE STE 200, BERKELEY, CA 947041014 (Tel: 5109391300)

📍
Updated Business Mailing Address June 14, 2022

Registered at 1918 BONITA AVE STE 200, BERKELEY, CA 947041014 (Tel: 1059391300)

NPI Profile Active July 19, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location July 19, 2017

Registered at 2201 COURAGE DR, FAIRFIELD, CA 945336733 (Tel: 7077848348)

📍
Updated Business Mailing Address July 19, 2017

Registered at 2201 COURAGE DR, FAIRFIELD, CA 945336733 (Tel: 7077848348)

👤
Provider Name / Credentials Updated July 19, 2017

Recorded as SHANDI FULLER, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 19, 2017

Pediatrics (License #A117119 in CA)

NPI Profile Active July 08, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2011

Registered at 1 HOSPITAL RD, CHEROKEE, NC 28719 (Tel: 8284979163)

📍
Updated Business Mailing Address July 08, 2011

Registered at 1 HOSPITAL RD, CHEROKEE, NC 28719 (Tel: 8284979163)

👤
Provider Name / Credentials Updated July 08, 2011

Recorded as SHANDI FULLER, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2011

Pediatrics (License #2008-00622 in NC)

🟢
Initial NPI Registration & Enumeration August 22, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1225285034
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 22, 2008
Last Update: June 14, 2022
Sole Proprietor: No

Mailing Address

1918 Bonita Ave Ste 200

Berkeley, CA 947041014

Phone: 1059391300

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.