Individual
SHAWNTALE RIDEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1850 FAIRWAY DR, SAN LEANDRO, CA 94577-5629
(510) 219-4876
Mailing address
1850 FAIRWAY DR, SAN LEANDRO, CA 94577-5629
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
735929
CA
Other
Enumeration date
10/14/2025
Last updated
10/14/2025
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