Provider Demographics
NPI:1356746283
Name:CLINKINBEARD, SHAUN
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:CLINKINBEARD
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 1:26692 TABLE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8960
Mailing Address - Country:US
Mailing Address - Phone:530-268-7423
Mailing Address - Fax:530-586-3603
Practice Address - Street 1:26692 TABLE MEADOW RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8960
Practice Address - Country:US
Practice Address - Phone:530-268-7423
Practice Address - Fax:530-586-3603
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion