Provider Demographics
NPI:1811797269
Name:SAWYER, SHANE THOMAS
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:THOMAS
Last Name:SAWYER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ACORN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3306
Mailing Address - Country:US
Mailing Address - Phone:949-217-8181
Mailing Address - Fax:
Practice Address - Street 1:290 S PROSPECT AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1523
Practice Address - Country:US
Practice Address - Phone:415-646-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician