Provider Demographics
NPI:1124905500
Name:SHEMSU, SHETAYE (RN, PHN, NP)
Entity type:Individual
Prefix:
First Name:SHETAYE
Middle Name:
Last Name:SHEMSU
Suffix:
Gender:F
Credentials:RN, PHN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HAWK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5819
Mailing Address - Country:US
Mailing Address - Phone:510-435-6026
Mailing Address - Fax:510-577-1876
Practice Address - Street 1:6955 FOOTHILL BLVD FL 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2455
Practice Address - Country:US
Practice Address - Phone:510-604-3203
Practice Address - Fax:510-577-1876
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23417363L00000X
CA3119364S00000X
CA727017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist