Provider Demographics
NPI:1023732096
Name:SHLEMIS, DAVID GREGORY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:SHLEMIS
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 1:943 BAINES ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2557
Mailing Address - Country:US
Mailing Address - Phone:408-595-4089
Mailing Address - Fax:
Practice Address - Street 1:943 BAINES ST
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2557
Practice Address - Country:US
Practice Address - Phone:408-595-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician