Healthcare Provider Details

I. General information

NPI: 1184937260
Provider Name (Legal Business Name): AMY B SHEFFTZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

IV. Provider business mailing address

PO BOX 1179
SODA SPRINGS CA
95728-1179
US

V. Phone/Fax

Practice location:
  • Phone: 916-764-7059
  • Fax:
Mailing address:
  • Phone: 916-764-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number742075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: