Provider Demographics
NPI:1407106495
Name:EWBANK, SHAWN CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:CHRISTOPHER
Last Name:EWBANK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 HELEN CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:424-272-6989
Mailing Address - Fax:
Practice Address - Street 1:2990 HELEN CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:424-272-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019655103TC0700X
CAPSY27334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical