Provider Demographics
NPI:1225677198
Name:SICAT, SHANNON HA DUYEN (NP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:HA DUYEN
Last Name:SICAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10960 BARCELONA CT # 5
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5162
Mailing Address - Country:US
Mailing Address - Phone:714-423-2371
Mailing Address - Fax:
Practice Address - Street 1:2617 E CHAPMAN AVE STE 109
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3245
Practice Address - Country:US
Practice Address - Phone:714-847-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012984363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology