Healthcare Provider Details

I. General information

NPI: 1376206615
Provider Name (Legal Business Name): TATEVIK ANDREA SHAUMYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 01/29/2023
Certification Date: 01/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W ALAMEDA AVE
BURBANK CA
91506-2938
US

IV. Provider business mailing address

2301 W ALAMEDA AVE
BURBANK CA
91506-2938
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-0590
  • Fax:
Mailing address:
  • Phone: 818-848-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95018669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: