MEDICARE: SHANIQUA BLEDSAW

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1457106254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIQUA BLEDSAW

Provider Business Mailing Address
First Line	:	1050 FULTON AVE STE 235
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-4299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 E OLIVE AVE APT 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93701-1320
Country	:	US
Telephone Number	:	559-724-7335
Fax Number	:

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

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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Directions to “ SHANIQUA BLEDSAW ” Practice Location

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