Provider Demographics
NPI:1992948715
Name:KENEALEY, SHAUNA (LM, CPM, IBCLC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:KENEALEY
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
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 165
Mailing Address - Street 2:
Mailing Address - City:COMPTCHE
Mailing Address - State:CA
Mailing Address - Zip Code:95427
Mailing Address - Country:US
Mailing Address - Phone:541-727-1907
Mailing Address - Fax:541-256-3772
Practice Address - Street 1:26020 COMPTCHE-UKIAH RD
Practice Address - Street 2:
Practice Address - City:COMPTCHE
Practice Address - State:CA
Practice Address - Zip Code:95427
Practice Address - Country:US
Practice Address - Phone:541-727-1907
Practice Address - Fax:541-256-3772
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-22176174N00000X, 174N00000X
CALM399176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN