Provider Demographics
NPI:1740758127
Name:PERRY, SHEENA MARIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 EDES AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1306
Mailing Address - Country:US
Mailing Address - Phone:510-835-3700
Mailing Address - Fax:
Practice Address - Street 1:8452 EDES AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1306
Practice Address - Country:US
Practice Address - Phone:510-835-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002272163W00000X
CA95276634163W00000X
TX1072592363LP0808X
MO2021050323363LP0808X
AZ300736363LP0808X
CA95020198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse