Provider Demographics
NPI:1851017859
Name:SHONLEY, NINA RAINE
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:RAINE
Last Name:SHONLEY
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 1:2888 LOKER AVE E STE 303
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:855-556-8249
Practice Address - Street 1:4842 MORNING CANYON RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4961
Practice Address - Country:US
Practice Address - Phone:760-330-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician