Provider Demographics
NPI:1629544820
Name:BARRON, SHEALYN MICHELLE
Entity type:Individual
Prefix:
First Name:SHEALYN
Middle Name:MICHELLE
Last Name:BARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 HAVEN LN APT B
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4716
Mailing Address - Country:US
Mailing Address - Phone:831-348-9404
Mailing Address - Fax:
Practice Address - Street 1:1345 HAVEN LN APT B
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4716
Practice Address - Country:US
Practice Address - Phone:831-348-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2024-08-20
Deactivation Date:2018-11-03
Deactivation Code:
Reactivation Date:2018-11-28
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA86331102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician