Provider Demographics
NPI:1306212782
Name:PUMA, SHAWNA ANTOINETTE (MED)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:ANTOINETTE
Last Name:PUMA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:ANTOINETTE
Other - Last Name:LINDSEY-VEIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 LONGBROOK WAY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-465-1694
Mailing Address - Fax:
Practice Address - Street 1:100 LONGBROOK WAY
Practice Address - Street 2:SUITE 20
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-465-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health