Provider Demographics
NPI:1407221351
Name:MEDRANO, SHAWNA RENEE
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RENEE
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N MARTY AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6552
Mailing Address - Country:US
Mailing Address - Phone:559-541-3231
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3020
Practice Address - Country:US
Practice Address - Phone:559-256-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist