Healthcare Provider Details

I. General information

NPI: 1316075427
Provider Name (Legal Business Name): SHELBY CHANDLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 KING ST
BERKELEY CA
94703-2129
US

IV. Provider business mailing address

2935 KING ST
BERKELEY CA
94703-2129
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-9144
  • Fax:
Mailing address:
  • Phone: 510-847-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MISS SHELBY ELIZABETH CHANDLER
Title or Position: INTERN COUNSELOR
Credential:
Phone: 510-847-9144