Provider Demographics
NPI:1548518657
Name:GADON, SHANA NICOLE
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:NICOLE
Last Name:GADON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 OVERLAND AVE APT 7106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4529
Mailing Address - Country:US
Mailing Address - Phone:805-588-7177
Mailing Address - Fax:
Practice Address - Street 1:1825 E THELBORN ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1442
Practice Address - Country:US
Practice Address - Phone:626-915-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program