Provider Demographics
NPI:1578620050
Name:SHAYEVICH, CLARA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:
Last Name:SHAYEVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GUERRERO ST
Mailing Address - Street 2:SUITE #415
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1066
Mailing Address - Country:US
Mailing Address - Phone:415-771-4072
Mailing Address - Fax:650-992-1426
Practice Address - Street 1:2320 SUTTER ST
Practice Address - Street 2:SUITE #101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3038
Practice Address - Country:US
Practice Address - Phone:415-771-4072
Practice Address - Fax:650-992-1426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6331363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0063310Medicaid
CA3608626Medicare UPIN
CAZZZ14287ZMedicare ID - Type Unspecified