MEDICARE: DR. NANCY SHANG SHIBAYAMA M.D.

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	207R00000X	Internal Medicine Physician	G077126	CA

General Provider Information

NPI Number	:	1346242674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY SHANG SHIBAYAMA M.D.

Provider Business Mailing Address
First Line	:	11795 EDUCATION ST
Second Line	:	STE 209
City	:	AUBURN
State	:	CA
Zip	:	95602-2469
Country	:	US
Telephone Number	:	530-886-6700
Fax Number	:	530-886-6701

Provider Business Practice Location Address
First Line	:	11795 EDUCATION ST
Second Line	:	STE 209
City	:	AUBURN
State	:	CA
Zip	:	95602-2469
Country	:	US
Telephone Number	:	530-886-6700
Fax Number	:	530-886-6701

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/11/2017

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