Healthcare Provider Details

I. General information

NPI: 1023470689
Provider Name (Legal Business Name): SHAUNTAVIA WARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUNTAVIA HARRIS FNP-C

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N HOLLYWOOD WAY
BURBANK CA
91505-3406
US

IV. Provider business mailing address

4515 SETON CENTER PKWY STE 215
AUSTIN TX
78759-5785
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 512-231-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008341
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130140
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: