Provider Demographics
NPI:1033825021
Name:FONES, SHAELYN (RN)
Entity Type:Individual
Prefix:
First Name:SHAELYN
Middle Name:
Last Name:FONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 VISTA WOOD CIR APT 21
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5753
Mailing Address - Country:US
Mailing Address - Phone:520-360-5290
Mailing Address - Fax:
Practice Address - Street 1:4258 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3706
Practice Address - Country:US
Practice Address - Phone:805-477-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95308934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse