Healthcare Provider Details

I. General information

NPI: 1275702425
Provider Name (Legal Business Name): LAURIE SUE SHANAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 HOWARD ST
SAN FRANCISCO CA
94103-4183
US

IV. Provider business mailing address

1385 MISSION ST SUITE 240
SAN FRANCISCO CA
94103-2623
US

V. Phone/Fax

Practice location:
  • Phone: 415-975-0908
  • Fax:
Mailing address:
  • Phone: 415-864-4002
  • Fax: 415-864-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: