Healthcare Provider Details

I. General information

NPI: 1427754043
Provider Name (Legal Business Name): SAVANNAH AVALON BEHARRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 HERITAGE LANE STE 150
SACRAMENTO CA
95815
US

IV. Provider business mailing address

1851 HERITAGE LANE STE 150
SACRAMENTO CA
95815
US

V. Phone/Fax

Practice location:
  • Phone: 916-913-0822
  • Fax:
Mailing address:
  • Phone: 916-913-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95312653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: