Healthcare Provider Details

I. General information

NPI: 1023908928
Provider Name (Legal Business Name): SARAH ANDREA SHEVENELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35735 BONADELLE AVE
MADERA CA
93636-8444
US

IV. Provider business mailing address

35735 BONADELLE AVE
MADERA CA
93636-8444
US

V. Phone/Fax

Practice location:
  • Phone: 559-974-3028
  • Fax:
Mailing address:
  • Phone: 559-974-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: