Healthcare Provider Details

I. General information

NPI: 1912360942
Provider Name (Legal Business Name): SHAWN ROSENLOF PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 N FINANCIAL DR
FRESNO CA
93720-2939
US

IV. Provider business mailing address

7170 N FINANCIAL DR
FRESNO CA
93720-2939
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-2945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY32049
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: