Healthcare Provider Details

I. General information

NPI: 1013095934
Provider Name (Legal Business Name): SHUNNAE A DESTEPHANO M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHUNNAE BAKER M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 CLAREMONT AVE STE B
OAKLAND CA
94618-1794
US

IV. Provider business mailing address

1336 SHERWOOD DR
CONCORD CA
94521-3350
US

V. Phone/Fax

Practice location:
  • Phone: 510-432-7301
  • Fax:
Mailing address:
  • Phone: 510-432-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: