Provider Demographics
NPI:1487193637
Name:DANESHRAD, SHANNON (PSYD, MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DANESHRAD
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 WILSHIRE BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3204
Mailing Address - Country:US
Mailing Address - Phone:310-271-2275
Mailing Address - Fax:
Practice Address - Street 1:9350 WILSHIRE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3204
Practice Address - Country:US
Practice Address - Phone:310-271-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024192103TC0700X
CA97344106H00000X
CAPSY34382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist