Healthcare Provider Details

I. General information

NPI: 1619883691
Provider Name (Legal Business Name): CHEYENNE NEWALLIS AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 MISSION COLLEGE BLVD
SANTA CLARA CA
95054-1214
US

IV. Provider business mailing address

2231 N TAPER AVE
SAN PEDRO CA
90731-1161
US

V. Phone/Fax

Practice location:
  • Phone: 408-523-3910
  • Fax:
Mailing address:
  • Phone: 310-427-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: