Healthcare Provider Details

I. General information

NPI: 1174986640
Provider Name (Legal Business Name): SHANNON CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 JOINER PKWY APT 43
LINCOLN CA
95648-2339
US

IV. Provider business mailing address

3810 ROSIN CT STE 170
SACRAMENTO CA
95834-1658
US

V. Phone/Fax

Practice location:
  • Phone: 916-209-3246
  • Fax:
Mailing address:
  • Phone: 916-283-8280
  • Fax: 916-283-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: