Provider Demographics
NPI:1235663709
Name:SAUSEDO, SHEANINE
Entity Type:Individual
Prefix:
First Name:SHEANINE
Middle Name:
Last Name:SAUSEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEANINE
Other - Middle Name:
Other - Last Name:SAUSEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 LAS JUNTAS ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1222
Mailing Address - Country:US
Mailing Address - Phone:925-228-1638
Mailing Address - Fax:
Practice Address - Street 1:614 LAS JUNTAS ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1222
Practice Address - Country:US
Practice Address - Phone:925-228-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist