Provider Demographics
NPI:1689190530
Name:LAURIE, TARA SHENAI (M ED)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SHENAI
Last Name:LAURIE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6808
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6808
Mailing Address - Country:US
Mailing Address - Phone:623-218-9488
Mailing Address - Fax:480-781-0701
Practice Address - Street 1:4701 S LAKESHORE DR STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7169
Practice Address - Country:US
Practice Address - Phone:480-831-8727
Practice Address - Fax:480-272-8708
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator