Provider Demographics
NPI:1487226783
Name:STUEMPFIG, SHAYNA M
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:M
Last Name:STUEMPFIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 SHOREPOINT CT APT 205
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5862
Mailing Address - Country:US
Mailing Address - Phone:530-680-0633
Mailing Address - Fax:
Practice Address - Street 1:2020 BONAR ST STE 301
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1793
Practice Address - Country:US
Practice Address - Phone:510-644-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4027103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool