Provider Demographics
NPI:1710318563
Name:SHAH, NANCY (PSY D)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 LANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3109
Mailing Address - Country:US
Mailing Address - Phone:858-246-6310
Mailing Address - Fax:858-246-7577
Practice Address - Street 1:2821 LANGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-3109
Practice Address - Country:US
Practice Address - Phone:858-246-6310
Practice Address - Fax:858-246-7577
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical