Healthcare Provider Details

I. General information

NPI: 1982515078
Provider Name (Legal Business Name): SHAAN SINGH DHILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

3520 E SHIELDS AVE STE 102
FRESNO CA
93726-6923
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-1008
  • Fax:
Mailing address:
  • Phone: 559-538-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95474635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: