Healthcare Provider Details

I. General information

NPI: 1902743115
Provider Name (Legal Business Name): SHANIYA YVETTE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E LUGONIA AVE APT A
REDLANDS CA
92374-2635
US

IV. Provider business mailing address

1274 CENTER COURT DRIVE SUITE 211 COVINA CA 91724
COVINA CA
91724
US

V. Phone/Fax

Practice location:
  • Phone: 725-772-0639
  • Fax:
Mailing address:
  • Phone: 626-339-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: