Healthcare Provider Details

I. General information

NPI: 1962848135
Provider Name (Legal Business Name): SHAWN SEVY RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 GOLDEN FOOTHILL PKWY 105
EL DORADO HILLS CA
95762-9608
US

IV. Provider business mailing address

PO BOX 4993
EL DORADO HILLS CA
95762-0027
US

V. Phone/Fax

Practice location:
  • Phone: 916-850-2726
  • Fax:
Mailing address:
  • Phone: 916-850-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHF00079051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: