Provider Demographics
NPI:1083057574
Name:SHISHIDO, AKI (CNM)
Entity Type:Individual
Prefix:
First Name:AKI
Middle Name:
Last Name:SHISHIDO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 QUAIL HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4234
Mailing Address - Country:US
Mailing Address - Phone:949-654-2727
Mailing Address - Fax:
Practice Address - Street 1:6817 QUAIL HILL PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4234
Practice Address - Country:US
Practice Address - Phone:949-654-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH367A00000X
NYF0015401367A00000X
CA235683367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife