Provider Demographics
NPI:1407948185
Name:SHABAN, DIANA LYNNE (MED)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNNE
Last Name:SHABAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:SHABAN LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 TRIMONT LN APT 200P
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-1280
Mailing Address - Country:US
Mailing Address - Phone:412-469-8220
Mailing Address - Fax:412-469-9365
Practice Address - Street 1:300 WEYMAN ROAD #120
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1520
Practice Address - Country:US
Practice Address - Phone:412-669-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007882-L103T00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health