Healthcare Provider Details

I. General information

NPI: 1609415140
Provider Name (Legal Business Name): SHANG KNESEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2020
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax:
Mailing address:
  • Phone: 415-533-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005524
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95014156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: