Individual
SHANNON FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.M.T.,C.R.
Contact information
Practice address
1101 STANDIFORD AVE STE B6, MODESTO, CA 95350-0981
(209) 484-5683
Mailing address
3628 NORTHERN DANCER DR, MODESTO, CA 95355-8456
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18345
CA
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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