Healthcare Provider Details

I. General information

NPI: 1386643534
Provider Name (Legal Business Name): SHAREN KNUDSEN JEFFRIES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAREN JEAN KNUDSEN M.D.

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD SUITE 201
REDLANDS CA
92373-4870
US

IV. Provider business mailing address

255 TERRACINA BLVD SUITE 201
REDLANDS CA
92373-4870
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2500
  • Fax: 909-798-9495
Mailing address:
  • Phone: 909-793-2500
  • Fax: 909-798-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA50970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: