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General NPI Number Information
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NPI Number | 1124905500
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Entity Type | Individual
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Provider Name | SHETAYE SHEMSU RN, PHN, NP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 6955 FOOTHILL BLVD FL 3
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City | OAKLAND
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State | CA
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Zip | 94605-2455
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Country | US
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Telephone | 510-604-3203
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Fax | 510-577-1876
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Provider Business Mailing Address
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Address Line | 305 HAWK RIDGE DR
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City | RICHMOND
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State | CA
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Zip | 94806-5819
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Country | US
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Telephone | 510-435-6026
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Fax | 510-577-1876
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 23417
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 3119
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 727017
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License Number State | CA
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