1790923142 NPI number — MS. SABRINA SHANETTE SHUMAKE MFT, TRAINEE

Table of content: MS. SABRINA SHANETTE SHUMAKE MFT, TRAINEE (NPI 1790923142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790923142 NPI number — MS. SABRINA SHANETTE SHUMAKE MFT, TRAINEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMAKE
Provider First Name:
SABRINA
Provider Middle Name:
SHANETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT, TRAINEE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790923142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 VALENCIA ST
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94103-3547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-864-2364
Provider Business Mailing Address Fax Number:
415-864-0116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 VALENCIA ST
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94103-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-864-2364
Provider Business Practice Location Address Fax Number:
415-864-0116
Provider Enumeration Date:
01/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: UNLICENSED ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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