Healthcare Provider Details

I. General information

NPI: 1619892080
Provider Name (Legal Business Name): SHAWNA MARCUS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 VAN NESS AVE
FRESNO CA
93721-2002
US

IV. Provider business mailing address

48019 THUNDERHILL LN
SQUAW VALLEY CA
93675-9698
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: