Healthcare Provider Details

I. General information

NPI: 1649893066
Provider Name (Legal Business Name): SARA SHADOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA SHADOWS 171M00000X

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

IV. Provider business mailing address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-8223
  • Fax: 661-822-9347
Mailing address:
  • Phone: 661-822-8223
  • Fax: 661-822-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: