# SHADELANDS ADVANCED ENDOSCOPY INSTITUTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184798837
- **Authorized official:** JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
- **Authorized official phone:** (615) 234-5954

## Contact information

- **Practice address:** 498 N WIGET LN, WALNUT CREEK, CA 94598-2408
- **Practice address phone:** (925) 933-3600
- **Practice address fax:** (925) 933-7900
- **Mailing address:** 498 N WIGET LN, WALNUT CREEK, CA 94598-2408
- **Mailing address phone:** (925) 948-8143
- **Mailing address fax:** (925) 215-4540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 05/20/2026