Provider Demographics
NPI:1376776492
Name:QURESHI, SHANNON CHAVEZ (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:CHAVEZ
Last Name:QURESHI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR SHANNON CHAVEZ
Mailing Address - Street 1:8484 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 715
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3235
Mailing Address - Country:US
Mailing Address - Phone:323-920-9473
Mailing Address - Fax:
Practice Address - Street 1:8484 WILSHIRE BLVD
Practice Address - Street 2:SUITE 715
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:323-920-9473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26924103TC0700X, 103TH0100X, 103TH0100X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty