Healthcare Provider Details

I. General information

NPI: 1699666891
Provider Name (Legal Business Name): SHANE LEDESMA AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 TECHNOLOGY DR
SAN JOSE CA
95110-1305
US

IV. Provider business mailing address

132 MOUNTAIN VIEW AVE
SANTA CRUZ CA
95062-3612
US

V. Phone/Fax

Practice location:
  • Phone: 408-436-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: