Individual
MR. SHAWNA DORENE AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTC
Contact information
Practice address
1409 E BRIGGSMORE AVE, MODESTO, CA 95355-2707
(209) 521-6097
(209) 572-4579
Mailing address
1409 E BRIGGSMORE AVE, MODESTO, CA 95355-2707
(209) 521-6097
(209) 572-4579
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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