Provider Demographics
NPI:1801138839
Name:SHAVERS, TABARI (CMT)
Entity type:Individual
Prefix:MR
First Name:TABARI
Middle Name:
Last Name:SHAVERS
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4600
Mailing Address - Country:US
Mailing Address - Phone:888-374-4469
Mailing Address - Fax:
Practice Address - Street 1:949 35TH ST
Practice Address - Street 2:5
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4245
Practice Address - Country:US
Practice Address - Phone:888-374-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41412174H00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator