Provider Demographics
NPI:1366489577
Name:STOTT, SHAUNA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:JEAN
Last Name:STOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:220 COUNTRY CLUB GATE CTR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5014
Mailing Address - Country:US
Mailing Address - Phone:831-646-1873
Mailing Address - Fax:831-372-3587
Practice Address - Street 1:220 COUNTRY CLUB GATE CTR
Practice Address - Street 2:SUITE 16
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5014
Practice Address - Country:US
Practice Address - Phone:831-646-1873
Practice Address - Fax:831-372-3587
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL93540Medicare ID - Type Unspecified