Healthcare Provider Details

I. General information

NPI: 1154275238
Provider Name (Legal Business Name): SHANNON ELIZABETH LEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON ELIZABETH ASSELLS

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 S BASCOM AVE STE 109
SAN JOSE CA
95124-2600
US

IV. Provider business mailing address

3880 S BASCOM AVE STE 109
SAN JOSE CA
95124-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-560-9470
  • Fax:
Mailing address:
  • Phone: 408-560-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: