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General NPI Number Information
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NPI Number | 1700089786
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Entity Type | Individual
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Provider Name | SHAINA NISHIMURA AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 8100 ROOSEVELT BLVD SUITE 202
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2900
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Country | US
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Telephone | 215-535-5598
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Fax |
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Provider Business Mailing Address
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Address Line | 719 HUNTERS LN
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-2814
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Country | US
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Telephone | 609-320-3332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 0021291
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 25MG00114200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AT006107
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | AT006107
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | AT006107
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 41YA00073700
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License Number State | NJ
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