Provider Demographics
NPI:1861751356
Name:CLEMMER, SHAWN
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:CLEMMER
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 1:1413 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4220
Mailing Address - Country:US
Mailing Address - Phone:916-452-2685
Mailing Address - Fax:916-452-4522
Practice Address - Street 1:1413 60TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-4220
Practice Address - Country:US
Practice Address - Phone:916-452-2685
Practice Address - Fax:916-452-4522
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13077174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian