Provider Demographics
NPI:1710348446
Name:TIATIA, SHAUNA
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:
Last Name:TIATIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:GREENING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2725 W WIGWAM AVE APT 1073
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6606
Mailing Address - Country:US
Mailing Address - Phone:702-338-2757
Mailing Address - Fax:
Practice Address - Street 1:2725 W WIGWAM AVE APT 1073
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6606
Practice Address - Country:US
Practice Address - Phone:702-338-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor