Provider Demographics
NPI:1467238261
Name:SHILLIG, ELLIANA SUZANNE
Entity Type:Individual
Prefix:
First Name:ELLIANA
Middle Name:SUZANNE
Last Name:SHILLIG
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 1:16800 CHUCHUPATE TRL
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225-9331
Mailing Address - Country:US
Mailing Address - Phone:661-912-2652
Mailing Address - Fax:
Practice Address - Street 1:16800 CHUCHUPATE TRL
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225-9331
Practice Address - Country:US
Practice Address - Phone:661-912-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747P1801X, 251E00000X, 332U00000X
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals