Provider Demographics
NPI:1639768393
Name:DANIELS VAN PATTEN, SHANI RENEE (CPM)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:RENEE
Last Name:DANIELS VAN PATTEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26819 TWILIGHT GROVE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1627
Mailing Address - Country:US
Mailing Address - Phone:832-928-1869
Mailing Address - Fax:
Practice Address - Street 1:1707 FM 1960 BYPASS RD E STE D
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3955
Practice Address - Country:US
Practice Address - Phone:832-558-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0Other0