Provider Demographics
NPI:1215226238
Name:MCNAIR, SHEENA (MS)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 MOORPARK AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1714
Mailing Address - Country:US
Mailing Address - Phone:408-249-0770
Mailing Address - Fax:408-834-7767
Practice Address - Street 1:4155 MOORPARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1714
Practice Address - Country:US
Practice Address - Phone:408-249-0770
Practice Address - Fax:408-834-7767
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6772OtherCALIFORNIA SLP LICENSE