Provider Demographics
NPI:1457342248
Name:TINDALL, SHAUNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:TINDALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 PAULINE BLVD
Mailing Address - Street 2:STE 13A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5047
Mailing Address - Country:US
Mailing Address - Phone:734-223-4148
Mailing Address - Fax:734-622-0661
Practice Address - Street 1:1945 PAULINE BLVD
Practice Address - Street 2:STE 13A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-223-4148
Practice Address - Fax:734-622-0661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical