Healthcare Provider Details

I. General information

NPI: 1063222875
Provider Name (Legal Business Name): SHANEE JOVAN FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 CARROLL AVE FL 2
SAN FRANCISCO CA
94124-3219
US

IV. Provider business mailing address

25200 CARLOS BEE BLVD APT 393
HAYWARD CA
94542-1541
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-8200
  • Fax: 415-822-6822
Mailing address:
  • Phone: 510-302-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: