Provider Demographics
NPI:1013341155
Name:SHAUNA COLLINS, MD INC.
Entity Type:Organization
Organization Name:SHAUNA COLLINS, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-585-2381
Mailing Address - Street 1:2277 TOWNSGATE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2406
Mailing Address - Country:US
Mailing Address - Phone:805-379-0522
Mailing Address - Fax:805-379-0622
Practice Address - Street 1:7657 WINNETKA AVE
Practice Address - Street 2:SUITE 344
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2677
Practice Address - Country:US
Practice Address - Phone:818-585-2381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty