Healthcare Provider Details

I. General information

NPI: 1467164178
Provider Name (Legal Business Name): SHAUNA GABRIELLA NISANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10468 LINDBROOK DR
LOS ANGELES CA
90024-3330
US

IV. Provider business mailing address

10468 LINDBROOK DR
LOS ANGELES CA
90024-3330
US

V. Phone/Fax

Practice location:
  • Phone: 310-818-6891
  • Fax:
Mailing address:
  • Phone: 310-818-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: