Provider Demographics
NPI:1023487295
Name:SHINN, MARYANN CIMINO
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:CIMINO
Last Name:SHINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 CALIFORNIA DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3201
Mailing Address - Country:US
Mailing Address - Phone:650-464-6922
Mailing Address - Fax:
Practice Address - Street 1:1733 CALIFORNIA DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3201
Practice Address - Country:US
Practice Address - Phone:650-464-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410508825376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator