Provider Demographics
NPI:1497528764
Name:SHENG, NATALIE EMMA
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:EMMA
Last Name:SHENG
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 1:620 SANTA CLARA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3352
Mailing Address - Country:US
Mailing Address - Phone:626-419-5069
Mailing Address - Fax:
Practice Address - Street 1:4000 CIVIC CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4151
Practice Address - Country:US
Practice Address - Phone:628-877-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist