Healthcare Provider Details

I. General information

NPI: 1417049933
Provider Name (Legal Business Name): MS. SHAUNA NICHELE LOWRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 COLEEN ST SUITE A
FONTANA CA
92337
US

IV. Provider business mailing address

16200 COLEEN ST
FONTANA CA
92337
US

V. Phone/Fax

Practice location:
  • Phone: 323-793-1842
  • Fax: 909-355-1826
Mailing address:
  • Phone: 323-793-1842
  • Fax: 909-355-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: