Provider Demographics
NPI:1578344230
Name:VAGARSHAKIAN, SHOUSHANNA (LMT)
Entity Type:Individual
Prefix:
First Name:SHOUSHANNA
Middle Name:
Last Name:VAGARSHAKIAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7019 IPE WOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5023
Mailing Address - Country:US
Mailing Address - Phone:702-301-1316
Mailing Address - Fax:
Practice Address - Street 1:2291 S FORT APACHE RD STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5895
Practice Address - Country:US
Practice Address - Phone:702-776-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.4514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist