Provider Demographics
NPI:1760142228
Name:THEOGENE, SHAIDINE MILIEN
Entity Type:Individual
Prefix:MISS
First Name:SHAIDINE
Middle Name:MILIEN
Last Name:THEOGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8048 CHALET PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3114
Mailing Address - Country:US
Mailing Address - Phone:619-559-6201
Mailing Address - Fax:
Practice Address - Street 1:8048 CHALET PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3114
Practice Address - Country:US
Practice Address - Phone:619-559-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician