Provider Demographics
NPI:1104937002
Name:CARDOZA, SHAWN FRANK (NP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:FRANK
Last Name:CARDOZA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7475
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290
Mailing Address - Country:US
Mailing Address - Phone:559-635-7800
Mailing Address - Fax:559-635-7805
Practice Address - Street 1:3130 W CALDWELL AVE.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-635-7800
Practice Address - Fax:559-635-7805
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR629ZOtherMEDICARE PTAN
CABR629ZOtherMEDICARE PTAN
CACA173385Medicare PIN