Provider Demographics
NPI:1235931684
Name:VARDANYAN, SHAWNA (DACCHM, LAC)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:
Last Name:VARDANYAN
Suffix:
Gender:
Credentials:DACCHM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 MEADOWLARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1530
Mailing Address - Country:US
Mailing Address - Phone:310-402-4143
Mailing Address - Fax:
Practice Address - Street 1:4849 VAN NUYS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2121
Practice Address - Country:US
Practice Address - Phone:310-402-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist