Provider Demographics
NPI:1164248530
Name:WASHBURN, SHAWNASIE DONALD (WD)
Entity type:Individual
Prefix:
First Name:SHAWNASIE
Middle Name:DONALD
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:WD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S TRINITY ST APT 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 S TRINITY ST APT 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1872
Practice Address - Country:US
Practice Address - Phone:559-603-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist