Provider Demographics
NPI:1265841860
Name:SHAH, TAMANNA
Entity Type:Individual
Prefix:MS
First Name:TAMANNA
Middle Name:
Last Name:SHAH
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 1:1445 BUTTE HOUSE RD STE F
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2749
Mailing Address - Country:US
Mailing Address - Phone:530-751-1122
Mailing Address - Fax:530-751-1122
Practice Address - Street 1:1445 BUTTE HOUSE RD STE F
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2749
Practice Address - Country:US
Practice Address - Phone:530-751-1122
Practice Address - Fax:530-751-1122
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health