Provider Demographics
NPI:1700343415
Name:GRIZOFFI, SHAWNA COLLEEN
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:COLLEEN
Last Name:GRIZOFFI
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 1:8247 E STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-8200
Mailing Address - Country:US
Mailing Address - Phone:916-478-5000
Mailing Address - Fax:
Practice Address - Street 1:8247 E STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8200
Practice Address - Country:US
Practice Address - Phone:916-478-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143942106H00000X
390200000X
CA129062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program