Healthcare Provider Details

I. General information

NPI: 1952266496
Provider Name (Legal Business Name): KATRINA SHANCE HAYWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 MARCONI AVE
SACRAMENTO CA
95821-4807
US

IV. Provider business mailing address

2435 MARCONI AVE
SACRAMENTO CA
95821-4807
US

V. Phone/Fax

Practice location:
  • Phone: 916-313-8420
  • Fax: 916-313-8420
Mailing address:
  • Phone: 916-313-8420
  • Fax: 916-313-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: