Provider Demographics
NPI:1215741145
Name:VUE, KEANU SHEELONG
Entity type:Individual
Prefix:
First Name:KEANU
Middle Name:SHEELONG
Last Name:VUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7034 E FEDORA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-9219
Mailing Address - Country:US
Mailing Address - Phone:559-720-0857
Mailing Address - Fax:
Practice Address - Street 1:6255 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5271
Practice Address - Country:US
Practice Address - Phone:559-341-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician