Healthcare Provider Details

I. General information

NPI: 1205482783
Provider Name (Legal Business Name): PAUL MI SHEFFIELD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

492 41ST ST APT C
OAKLAND CA
94609-2535
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-6621
  • Fax:
Mailing address:
  • Phone: 510-213-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number753759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: