Provider Demographics
NPI:1508999087
Name:SHOEMAKE, WAYDE ISAHN (BA)
Entity Type:Individual
Prefix:MR
First Name:WAYDE
Middle Name:ISAHN
Last Name:SHOEMAKE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4590 ALLSTATE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1702
Mailing Address - Country:US
Mailing Address - Phone:909-599-1227
Mailing Address - Fax:909-542-0210
Practice Address - Street 1:762 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3505
Practice Address - Country:US
Practice Address - Phone:909-599-1227
Practice Address - Fax:909-542-0210
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator