Healthcare Provider Details

I. General information

NPI: 1417543208
Provider Name (Legal Business Name): SHYLA ANN EVERETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

IV. Provider business mailing address

768 PLEASANT VALLEY RD
DIAMOND SPRINGS CA
95619-9260
US

V. Phone/Fax

Practice location:
  • Phone: 916-292-8060
  • Fax:
Mailing address:
  • Phone: 530-621-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: