Healthcare Provider Details

I. General information

NPI: 1912833625
Provider Name (Legal Business Name): JODI LYNN SHIELDS CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SCHOOL ST
NAPA CA
94559-2828
US

IV. Provider business mailing address

2743 KILBURN AVE
NAPA CA
94558-5622
US

V. Phone/Fax

Practice location:
  • Phone: 510-316-8077
  • Fax:
Mailing address:
  • Phone: 510-316-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number36786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: