Healthcare Provider Details

I. General information

NPI: 1013448281
Provider Name (Legal Business Name): NICOLE SHAHDEE EVANS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 10/27/2023
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD # M115
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

2425 GEARY BLVD # M115
SAN FRANCISCO CA
94115-3358
US

V. Phone/Fax

Practice location:
  • Phone: 628-214-8739
  • Fax:
Mailing address:
  • Phone: 628-214-8739
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: