Provider Demographics
NPI:1033966932
Name:MCDANIEL, AMIYAH SHON'NYCE
Entity type:Individual
Prefix:
First Name:AMIYAH
Middle Name:SHON'NYCE
Last Name:MCDANIEL
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 1:9586 SUNFLOWER RD # A
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CA
Mailing Address - Zip Code:95693-9739
Mailing Address - Country:US
Mailing Address - Phone:916-280-7568
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 340
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3225
Practice Address - Country:US
Practice Address - Phone:916-254-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator