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NPI Code Detail

MEDICARE: MS. SHANDA DAE PELLETIER

MEDICARE: MS. SHANDA DAE PELLETIER
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1689792954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANDA DAE PELLETIER
Provider Business Mailing Address
First Line : 3491 ELM AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4430
Country : US
Telephone Number : 562-427-4864
Fax Number : 562-427-4968
Provider Business Practice Location Address
First Line : 3491 ELM AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4430
Country : US
Telephone Number : 562-427-4864
Fax Number : 562-427-4968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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Directions to “ MS. SHANDA DAE PELLETIER ” Practice Location

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