Provider Demographics
NPI:1710630017
Name:SHAEVEL, SYDNEY RAE (AMFT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RAE
Last Name:SHAEVEL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 MANITOBA ST # D229
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8644
Mailing Address - Country:US
Mailing Address - Phone:310-612-0013
Mailing Address - Fax:
Practice Address - Street 1:8180 MANITOBA ST # D229
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8644
Practice Address - Country:US
Practice Address - Phone:310-612-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health