Provider Demographics
NPI:1720962244
Name:VODOS, SHELLY MAI
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MAI
Last Name:VODOS
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 1:5321 COLDWATER CANYON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6136
Mailing Address - Country:US
Mailing Address - Phone:818-478-0572
Mailing Address - Fax:818-784-0907
Practice Address - Street 1:5321 COLDWATER CANYON AVE APT B
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-6136
Practice Address - Country:US
Practice Address - Phone:818-478-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst