Healthcare Provider Details

I. General information

NPI: 1013740034
Provider Name (Legal Business Name): JEANETTE SHEKELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 7M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

35 MILLER AVE # 126
MILL VALLEY CA
94941-1903
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: