Healthcare Provider Details

I. General information

NPI: 1083984447
Provider Name (Legal Business Name): SHAENA WAN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 SPORTSMANS DR
NORTH LAUDERDALE FL
33068-5480
US

IV. Provider business mailing address

7208 SPORTSMANS DR
NORTH LAUDERDALE FL
33068-5480
US

V. Phone/Fax

Practice location:
  • Phone: 754-235-7936
  • Fax:
Mailing address:
  • Phone: 754-235-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: