Provider Demographics
NPI:1952946634
Name:SHADE, KELLEN (ND)
Entity type:Individual
Prefix:DR
First Name:KELLEN
Middle Name:
Last Name:SHADE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-8714
Mailing Address - Country:US
Mailing Address - Phone:831-594-7258
Mailing Address - Fax:831-855-1183
Practice Address - Street 1:NE CORNER OF SAN CARLOS AND OCEAN
Practice Address - Street 2:
Practice Address - City:CARMEL BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:93921
Practice Address - Country:US
Practice Address - Phone:831-583-8815
Practice Address - Fax:831-855-1183
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1123175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath