MEDICARE: SHAWN BARTON HERSEVOORT M.D., M.P.H.

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	2084P0800X	Psychiatry Physician	A88489	CA

General Provider Information

NPI Number	:	1518013317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN BARTON HERSEVOORT M.D., M.P.H.

Provider Business Mailing Address
First Line	:	2855 TELEGRAPH AVE STE 515
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-1151
Country	:	US
Telephone Number	:	877-768-7075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 TELEGRAPH AVE STE 515
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-1151
Country	:	US
Telephone Number	:	877-768-7075
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	02/09/2022

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