Healthcare Provider Details

I. General information

NPI: 1699653535
Provider Name (Legal Business Name): SHAUNA SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 OLD SAN JOSE RD
SOQUEL CA
95073-9453
US

IV. Provider business mailing address

3042 OLD SAN JOSE RD
SOQUEL CA
95073-9453
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-6812
  • Fax:
Mailing address:
  • Phone: 831-475-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: