Provider Demographics
NPI:1609105923
Name:FERRIS, SHAWN H
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:H
Last Name:FERRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57407 29 PALMS HWY STE F
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2907
Mailing Address - Country:US
Mailing Address - Phone:760-366-1541
Mailing Address - Fax:760-228-1614
Practice Address - Street 1:57407 29 PALMS HWY STE F
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-366-1541
Practice Address - Fax:760-228-1614
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator