Healthcare Provider Details

I. General information

NPI: 1841088473
Provider Name (Legal Business Name): SHANITA GUY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 S BROADWAY
LOS ANGELES CA
90003-3635
US

IV. Provider business mailing address

16129 HAWTHORNE BLVD STE D1022
LAWNDALE CA
90260-2928
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-1196
  • Fax:
Mailing address:
  • Phone: 310-946-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95018935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: