Basic Information
| Provider Information | |||||||||
| NPI: | 1730549080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNESARA | ||||||||
| FirstName: | SHABANA | ||||||||
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| Credential: | APRN-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 CUSTOMER CARE WAY | ||||||||
| Address2: | |||||||||
| City: | ATWATER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953015167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093846488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2760 3RD ST | ||||||||
| Address2: | |||||||||
| City: | CERES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095565011 | ||||||||
| FaxNumber: | 2095565095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2016 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP130246 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | NP95007976 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MS4739922 | 01 | CA | DEA | OTHER |