Healthcare Provider Details

I. General information

NPI: 1932778537
Provider Name (Legal Business Name): SHANNON MICHELLE MALINDZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 LIBERTY ST
FREMONT CA
94538-2211
US

IV. Provider business mailing address

1628 SAN MIGUEL DR
WALNUT CREEK CA
94596-4869
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax:
Mailing address:
  • Phone: 925-918-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95216988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: