Healthcare Provider Details

I. General information

NPI: 1508696378
Provider Name (Legal Business Name): TAMARA SHAMIEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

IV. Provider business mailing address

986 SUNSET DR
SAN CARLOS CA
94070-3635
US

V. Phone/Fax

Practice location:
  • Phone: 415-793-9403
  • Fax:
Mailing address:
  • Phone: 415-793-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: