MEDICARE: SHAE VANBUSKIRK

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	106S00000X	Behavior Technician		CA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811529068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAE VANBUSKIRK

Provider Business Mailing Address
First Line	:	36947 COOK ST STE 104
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36947 COOK ST STE 104
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:	951-363-0200
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	01/18/2022

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Directions to “ SHAE VANBUSKIRK ” Practice Location

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