Provider Demographics
NPI:1740035302
Name:TRESIDDER, SUNSHINE ANITA
Entity type:Individual
Prefix:
First Name:SUNSHINE
Middle Name:ANITA
Last Name:TRESIDDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:LEE
Other - Last Name:TRESIDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM, CMT
Mailing Address - Street 1:4677 VALLEY EAST BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4630
Mailing Address - Country:US
Mailing Address - Phone:707-633-3009
Mailing Address - Fax:
Practice Address - Street 1:4677 VALLEY EAST BLVD # 2
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4630
Practice Address - Country:US
Practice Address - Phone:707-633-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67041225700000X
CA733176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist