Provider Demographics
NPI:1386643534
Name:JEFFRIES, SHAREN KNUDSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAREN
Middle Name:KNUDSEN
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAREN
Other - Middle Name:JEAN
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:255 TERRACINA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-793-2500
Mailing Address - Fax:909-798-9495
Practice Address - Street 1:255 TERRACINA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2500
Practice Address - Fax:909-798-9495
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50970207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A509700Medicaid
E-36665Medicare UPIN
CA00A509700Medicare ID - Type Unspecified