Provider Demographics
NPI:1891388773
Name:MENENDEZ, SHAWN EILEEN (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:EILEEN
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 AMY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1520
Mailing Address - Country:US
Mailing Address - Phone:714-488-5694
Mailing Address - Fax:
Practice Address - Street 1:5422 AMY AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1520
Practice Address - Country:US
Practice Address - Phone:714-488-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA691029163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant