Provider Demographics
NPI:1285984690
Name:PINESETT, SHANNON KAY
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:PINESETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:KAY
Other - Last Name:SAENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2307 FENTON PKWY # 107-246
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4746
Mailing Address - Country:US
Mailing Address - Phone:714-655-6424
Mailing Address - Fax:
Practice Address - Street 1:2307 FENTON PKWY # 107-246
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4746
Practice Address - Country:US
Practice Address - Phone:714-655-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16977103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst