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General NPI Number Information
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NPI Number | 1083300016
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Entity Type | Individual
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Provider Name | SHAUNTON STUBBS DO
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Gender | Male
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1400 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4422
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Country | US
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Telephone | 209-573-6183
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 SHAMROCK ST
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City | BOISE
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State | ID
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Zip | 83713-2537
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Country | US
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Telephone | 208-230-3798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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