Provider Demographics
NPI:1518504216
Name:SHAMIRYAN, MANE (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MANE
Middle Name:
Last Name:SHAMIRYAN
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 GLENOAKS BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-6023
Mailing Address - Country:US
Mailing Address - Phone:818-404-0081
Mailing Address - Fax:
Practice Address - Street 1:7017 VAN NUYS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3095
Practice Address - Country:US
Practice Address - Phone:818-616-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty