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General NPI Number Information
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NPI Number | 1730549080
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Entity Type | Individual
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Provider Name | SHABANA SUNESARA APRN-FNP
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2760 3RD ST
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City | CERES
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State | CA
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Zip | 95307
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Country | US
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Telephone | 209-556-5011
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Fax | 209-556-5095
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-384-6488
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP130246
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95007976
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License Number State | CA
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