Provider Demographics
NPI:1851751358
Name:NAGEL, SHAYNA ANN
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ANN
Last Name:NAGEL
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 1:4627 COLDWATER CANYON AVE
Mailing Address - Street 2:#105
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1065
Mailing Address - Country:US
Mailing Address - Phone:818-441-4091
Mailing Address - Fax:
Practice Address - Street 1:4627 COLDWATER CANYON AVE
Practice Address - Street 2:#105
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1065
Practice Address - Country:US
Practice Address - Phone:818-441-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 71356104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker