Provider Demographics
NPI:1417113556
Name:SILVERSTEIN, SHANNON I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:SILVERSTEIN
Suffix:I
Gender:F
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:PO BOX 1955
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-1955
Mailing Address - Country:US
Mailing Address - Phone:760-617-1939
Mailing Address - Fax:
Practice Address - Street 1:12540 10TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3503
Practice Address - Country:US
Practice Address - Phone:909-364-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical