Shavontay Jenaye Brooks, REGISTERED NURSE
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Ceres, CA
NPI 1801639786 · NPPES record last updated Jun 26, 2024
Key facts
- NPI
- 1801639786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- 95203368 (CA)
- Practice address
- 1904 Richland Ave
Ceres, CA 95307-4562 - Phone
- (209) 300-8800
- NPI assigned
- Jun 17, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95203368 | CA | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 95203368 | CA | Yes |
Addresses
Primary practice location
1904 Richland Ave
Ceres, CA 95307-4562
Mailing address
934 Honeysuckle Ave
Patterson, CA 95363-8100
Phone (510) 914-0087
Other providers in Ceres, CA
- Joel Brambila I
- Adrian Bravo
- Kristina Brenner
- James F Briggs
- Porsha Brooks
- Daesha Brown
- Daniel Wayne Brown Jr.
- Garry Henry Brown
- Julia Lynette Brown
- Samantha Ann Bruno
All providers in Ceres, CA · Psychiatric/Mental Health Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.