Provider Demographics
NPI:1295291151
Name:SHANDS, SHNAVIAN
Entity type:Individual
Prefix:
First Name:SHNAVIAN
Middle Name:
Last Name:SHANDS
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 1:6958 KENNY LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2640
Mailing Address - Country:US
Mailing Address - Phone:757-645-5595
Mailing Address - Fax:
Practice Address - Street 1:6958 KENNY LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2640
Practice Address - Country:US
Practice Address - Phone:757-645-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities