MEDICARE: STEPHANIE MIYUKI SHIMADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	95233415	CA

General Provider Information

NPI Number	:	1184557498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MIYUKI SHIMADA

Provider Business Mailing Address
First Line	:	PO BOX 4334
Second Line	:
City	:	BLUE JAY
State	:	CA
Zip	:	92317-4334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 GOLF COURSE RD
Second Line	:
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352
Country	:	US
Telephone Number	:	949-659-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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