Provider Demographics
NPI:1891522694
Name:SHIN, JAYLEE MAYA
Entity type:Individual
Prefix:
First Name:JAYLEE
Middle Name:MAYA
Last Name:SHIN
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 1:5012 PROCTOR RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1421
Mailing Address - Country:US
Mailing Address - Phone:510-646-6164
Mailing Address - Fax:
Practice Address - Street 1:5601 ARNOLD RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7724
Practice Address - Country:US
Practice Address - Phone:925-462-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician