Provider Demographics
NPI:1790877785
Name:SANDRA J. SHETZLINE, DO INC
Entity Type:Organization
Organization Name:SANDRA J. SHETZLINE, DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHETZLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-795-4488
Mailing Address - Street 1:602 SHEEP RANCH RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-9705
Mailing Address - Country:US
Mailing Address - Phone:209-795-4488
Mailing Address - Fax:209-795-0984
Practice Address - Street 1:2740 HIGHWAY 4
Practice Address - Street 2:DRAWER V
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223
Practice Address - Country:US
Practice Address - Phone:209-795-4488
Practice Address - Fax:209-794-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty