1689190530 NPI number — TARA SHENAI LAURIE M. ED

Table of content: TARA SHENAI LAURIE M. ED (NPI 1689190530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689190530 NPI number — TARA SHENAI LAURIE M. ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAURIE
Provider First Name:
TARA
Provider Middle Name:
SHENAI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689190530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85246-6808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-218-9488
Provider Business Mailing Address Fax Number:
480-781-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 S LAKESHORE DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-831-8727
Provider Business Practice Location Address Fax Number:
480-272-8708
Provider Enumeration Date:
08/22/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)