Provider Demographics
NPI:1467164178
Name:NISANI, SHAUNA GABRIELLA
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:GABRIELLA
Last Name:NISANI
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 1:10468 LINDBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3330
Mailing Address - Country:US
Mailing Address - Phone:310-818-6891
Mailing Address - Fax:
Practice Address - Street 1:10468 LINDBROOK DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3330
Practice Address - Country:US
Practice Address - Phone:310-818-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer