Healthcare Provider Details

I. General information

NPI: 1992516306
Provider Name (Legal Business Name): SHANIECE YVETTE CHAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD STE 810
LOS ANGELES CA
90025-1166
US

IV. Provider business mailing address

12121 WILSHIRE BLVD STE 810
LOS ANGELES CA
90025-1166
US

V. Phone/Fax

Practice location:
  • Phone: 888-684-2779
  • Fax:
Mailing address:
  • Phone: 888-684-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number29859
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29859
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: