Provider Demographics
NPI:1659837094
Name:SHANGHAI, SANDRINE (RN, BSN,RBT)
Entity type:Individual
Prefix:MS
First Name:SANDRINE
Middle Name:
Last Name:SHANGHAI
Suffix:
Gender:F
Credentials:RN, BSN,RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 BEECHWOOD TERRACE #300
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:616-914-9157
Mailing Address - Fax:
Practice Address - Street 1:44933 GEORGE WASHINGTON PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:844-244-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2020-03-25
Deactivation Date:2020-03-13
Deactivation Code:
Reactivation Date:2020-03-25
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 171M00000X
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator