Provider Demographics
NPI:1376206615
Name:SHAUMYAN, TATEVIK ANDREA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TATEVIK
Middle Name:ANDREA
Last Name:SHAUMYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2938
Mailing Address - Country:US
Mailing Address - Phone:818-848-0590
Mailing Address - Fax:
Practice Address - Street 1:2301 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2938
Practice Address - Country:US
Practice Address - Phone:818-848-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner