MEDICARE: JENISE LYNN SHIN-LEE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-00-0028	CA

General Provider Information

NPI Number	:	1033493531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENISE LYNN SHIN-LEE BCBA

Provider Business Mailing Address
First Line	:	1901 ROYAL OAKS DR STE 201
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4235
Country	:	US
Telephone Number	:	916-923-1500
Fax Number	:	916-923-1515

Provider Business Practice Location Address
First Line	:	1901 ROYAL OAKS DR STE 201
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4235
Country	:	US
Telephone Number	:	916-923-1500
Fax Number	:	916-923-1515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/03/2011

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