Shane Nibley

NPI 1255200846 · on the registry since 2025

Practice

Address: 3079 Harrison Ave
South Lake Tahoe, CA 96150
Phone: (530) 957-6254
Organisation at this address: Mnt Scientific
Eat Beyond Labels Inc
Sierra Mental Wellness Group
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 21

Registry record

Primary taxonomy: 225400000X
225400000X
Also registered as: 171M00000X
373H00000X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2025-12-11

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California