Healthcare Provider Details

I. General information

NPI: 1255252367
Provider Name (Legal Business Name): SHEVON LANEE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAY WALKER

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 ODESSA LN
SACRAMENTO CA
95834-7664
US

IV. Provider business mailing address

3619 ODESSA LN
SACRAMENTO CA
95834-7664
US

V. Phone/Fax

Practice location:
  • Phone: 209-740-6207
  • Fax:
Mailing address:
  • Phone: 209-740-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: