Provider Demographics
NPI:1700089786
Name:NISHIMURA, SHAINA (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHAINA
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2814
Mailing Address - Country:US
Mailing Address - Phone:609-320-3332
Mailing Address - Fax:
Practice Address - Street 1:8100 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2900
Practice Address - Country:US
Practice Address - Phone:215-535-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0021291231H00000X
NJ25MG00114200237600000X
PAAT006107237600000X, 231HA2400X, 231HA2500X
NJ41YA00073700231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier