Provider Demographics
NPI:1760036297
Name:SHEAFFER, BETHANIE (LEP, PPS)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:
Last Name:SHEAFFER
Suffix:
Gender:F
Credentials:LEP, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2040
Mailing Address - Country:US
Mailing Address - Phone:703-507-7225
Mailing Address - Fax:
Practice Address - Street 1:10301 VISTA DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2040
Practice Address - Country:US
Practice Address - Phone:703-507-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist