Healthcare Provider Details

I. General information

NPI: 1821763590
Provider Name (Legal Business Name): SHAFTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 12/29/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MUNZER ST SUITE C
SHAFTER CA
93263-2042
US

IV. Provider business mailing address

P.O. BOX 22694
BAKERSFIELD CA
93390-2694
US

V. Phone/Fax

Practice location:
  • Phone: 661-630-5274
  • Fax: 661-630-5290
Mailing address:
  • Phone: 661-630-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AYODEJI ADETAYO AYENI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 661-364-5244