Provider Demographics
NPI:1134098478
Name:JENNETT, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:JENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ENCINA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2343
Mailing Address - Country:US
Mailing Address - Phone:650-853-0321
Mailing Address - Fax:650-853-0359
Practice Address - Street 1:33 ENCINA AVE STE 103
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2343
Practice Address - Country:US
Practice Address - Phone:650-853-0321
Practice Address - Fax:650-853-0359
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health