Provider Demographics
NPI:1881130128
Name:ROBNETT, SHAYNA MARIA (CO 60639490)
Entity type:Individual
Prefix:MRS
First Name:SHAYNA
Middle Name:MARIA
Last Name:ROBNETT
Suffix:
Gender:F
Credentials:CO 60639490
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4012
Mailing Address - Country:US
Mailing Address - Phone:360-452-4432
Mailing Address - Fax:
Practice Address - Street 1:933 E 1ST ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4012
Practice Address - Country:US
Practice Address - Phone:360-452-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60639490261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder