Healthcare Provider Details

I. General information

NPI: 1851201347
Provider Name (Legal Business Name): BRIAN SHINTAKU BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

IV. Provider business mailing address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

V. Phone/Fax

Practice location:
  • Phone: 208-465-4833
  • Fax: 208-467-2654
Mailing address:
  • Phone: 208-465-4833
  • Fax: 208-467-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: