Healthcare Provider Details

I. General information

NPI: 1750795548
Provider Name (Legal Business Name): HEATHER ELLEN SHAMIEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HAYES ST
SAN FRANCISCO CA
94117-1128
US

IV. Provider business mailing address

2020 HAYES ST
SAN FRANCISCO CA
94117-1128
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5125
  • Fax: 415-221-2678
Mailing address:
  • Phone: 415-750-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA8650313
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: