Healthcare Provider Details

I. General information

NPI: 1629203898
Provider Name (Legal Business Name): SHAWNA BETH ARSENAULT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7041
  • Fax: 916-734-7838
Mailing address:
  • Phone: 916-734-7041
  • Fax: 916-734-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA137053
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberA137053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: