Provider Demographics
NPI:1760658082
Name:SHAUF, JASON Q
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:Q
Last Name:SHAUF
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 1:147 VISTA DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6335
Mailing Address - Country:US
Mailing Address - Phone:408-390-5065
Mailing Address - Fax:
Practice Address - Street 1:1420 CUCIZ LN
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8206
Practice Address - Country:US
Practice Address - Phone:408-390-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist