Healthcare Provider Details

I. General information

NPI: 1629905492
Provider Name (Legal Business Name): SHAUNTI STANFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39510 PASEO PADRE PKWY STE 190
FREMONT CA
94538-4716
US

IV. Provider business mailing address

25836 HAYWARD BLVD APT 311
HAYWARD CA
94542-1685
US

V. Phone/Fax

Practice location:
  • Phone: 510-980-4113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: