Provider Demographics
NPI:1548837487
Name:TAGURAN, SHAINA
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:
Last Name:TAGURAN
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 1:3459 VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-5184
Mailing Address - Country:US
Mailing Address - Phone:310-903-0279
Mailing Address - Fax:
Practice Address - Street 1:11126 CORONA AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11368-4027
Practice Address - Country:US
Practice Address - Phone:718-592-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY792913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse