Provider Demographics
NPI:1083951412
Name:AMIN-SHINNETTE, SHIVA (PH D)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:AMIN-SHINNETTE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WINTHROP CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4219
Mailing Address - Country:US
Mailing Address - Phone:559-269-5036
Mailing Address - Fax:
Practice Address - Street 1:5701 LONETREE BLVD STE 108E
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3792
Practice Address - Country:US
Practice Address - Phone:559-269-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27183103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty