Provider Demographics
NPI:1477500981
Name:SHUTE, GERALDINE MARY (LAC)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARY
Last Name:SHUTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2150
Mailing Address - Country:US
Mailing Address - Phone:510-215-7957
Mailing Address - Fax:
Practice Address - Street 1:1240 POWELL ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2600
Practice Address - Country:US
Practice Address - Phone:510-672-2210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0105410OtherBLUE SHIELD CA PROVIDER #