Healthcare Provider Details

I. General information

NPI: 1992616692
Provider Name (Legal Business Name): JILLIAN DENISE SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 HILL RD APT 9
NOVATO CA
94947-7324
US

IV. Provider business mailing address

1510 HILL RD APT 9
NOVATO CA
94947-7324
US

V. Phone/Fax

Practice location:
  • Phone: 510-306-1531
  • Fax:
Mailing address:
  • Phone: 415-594-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: