Provider Demographics
NPI:1760198485
Name:ELIACIN, SHANONE
Entity Type:Individual
Prefix:
First Name:SHANONE
Middle Name:
Last Name:ELIACIN
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 1:33300 MISSION BLVD APT 165
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1447
Mailing Address - Country:US
Mailing Address - Phone:954-825-3079
Mailing Address - Fax:
Practice Address - Street 1:33300 MISSION BLVD APT 165
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1447
Practice Address - Country:US
Practice Address - Phone:954-825-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant