Healthcare Provider Details

I. General information

NPI: 1093650020
Provider Name (Legal Business Name): TIFFANYE NICOLE SHEDRICK-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD
LOS ANGELES CA
90045-3631
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD
LOS ANGELES CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-9737
  • Fax: --
Mailing address:
  • Phone: 310-795-9737
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: