Provider Demographics
NPI:1982173142
Name:ALLEN, SHAUN MICHAEL
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:MICHAEL
Last Name:ALLEN
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 1:7770 TINA CT
Mailing Address - Street 2:
Mailing Address - City:LOS MOLINOS
Mailing Address - State:CA
Mailing Address - Zip Code:96055-9732
Mailing Address - Country:US
Mailing Address - Phone:530-624-3182
Mailing Address - Fax:
Practice Address - Street 1:7770 TINA CT
Practice Address - Street 2:
Practice Address - City:LOS MOLINOS
Practice Address - State:CA
Practice Address - Zip Code:96055-9732
Practice Address - Country:US
Practice Address - Phone:530-624-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide