Provider Demographics
NPI:1750318507
Name:SHOEMAKER, JAMES EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 KADEMA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6914
Mailing Address - Country:US
Mailing Address - Phone:916-443-0974
Mailing Address - Fax:916-254-0112
Practice Address - Street 1:5411 MADISON AVE
Practice Address - Street 2:STE # 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3151
Practice Address - Country:US
Practice Address - Phone:916-332-6051
Practice Address - Fax:916-332-6053
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPIN#: 00PL67761Medicare ID - Type Unspecified