Provider Demographics
NPI:1639571177
Name:ROSSELI, SHAY-ANNE
Entity Type:Individual
Prefix:
First Name:SHAY-ANNE
Middle Name:
Last Name:ROSSELI
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 1:15450 COUNTY ROAD 99
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-9339
Mailing Address - Country:US
Mailing Address - Phone:530-668-9627
Mailing Address - Fax:530-668-8528
Practice Address - Street 1:15450 COUNTY ROAD 99
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-9339
Practice Address - Country:US
Practice Address - Phone:530-668-9627
Practice Address - Fax:530-668-8528
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility