Provider Demographics
NPI:1316132947
Name:NANCY SHIBAYAMA, M.D., INC
Entity type:Organization
Organization Name:NANCY SHIBAYAMA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIBAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-886-6700
Mailing Address - Street 1:11795 EDUCATION ST
Mailing Address - Street 2:SUITE #209
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2469
Mailing Address - Country:US
Mailing Address - Phone:530-886-6700
Mailing Address - Fax:530-886-6701
Practice Address - Street 1:11795 EDUCATION ST
Practice Address - Street 2:SUITE #209
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2454
Practice Address - Country:US
Practice Address - Phone:530-886-6700
Practice Address - Fax:530-886-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39465Medicare UPIN
CAZZZ01446ZMedicare PIN