Provider Demographics
NPI:1750634259
Name:SHAMOIEL, SHANTAL
Entity Type:Individual
Prefix:
First Name:SHANTAL
Middle Name:
Last Name:SHAMOIEL
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 1:4005 COWELL BLVD APT 507
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6016
Mailing Address - Country:US
Mailing Address - Phone:310-756-5574
Mailing Address - Fax:
Practice Address - Street 1:6147 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2738
Practice Address - Country:US
Practice Address - Phone:310-756-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 55117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist