Healthcare Provider Details

I. General information

NPI: 1972419620
Provider Name (Legal Business Name): SHAELYN E MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9759 TRALEE WAY
ELK GROVE CA
95624-2678
US

IV. Provider business mailing address

9513 EMERALD PARK DR
ELK GROVE CA
95624-2374
US

V. Phone/Fax

Practice location:
  • Phone: 925-890-6255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT25493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: