Provider Demographics
NPI:1053647578
Name:SHANAHAN-ORTEGA, SIOBHAN KAY (LPT)
Entity Type:Individual
Prefix:MRS
First Name:SIOBHAN
Middle Name:KAY
Last Name:SHANAHAN-ORTEGA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 G ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1643
Mailing Address - Country:US
Mailing Address - Phone:559-459-0334
Mailing Address - Fax:
Practice Address - Street 1:1206 G ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1643
Practice Address - Country:US
Practice Address - Phone:559-459-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33317167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician