Healthcare Provider Details

I. General information

NPI: 1942070669
Provider Name (Legal Business Name): SHELBY NACCARATO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/23/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD # 319 4411 E. CESAR CHAVEZ BLVD #319
FRESNO CA
93702-3604
US

IV. Provider business mailing address

3115 N. MILLBROOK AVE FRESNO CA 93703 3115 N. MILLBROOK AVE FRESNO CA 93703
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-2382
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number735413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: