Provider Demographics
NPI:1932144177
Name:REVILLE, SHARI M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:M
Last Name:REVILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 N PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4411
Mailing Address - Country:US
Mailing Address - Phone:760-403-0573
Mailing Address - Fax:760-318-2030
Practice Address - Street 1:1276 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4411
Practice Address - Country:US
Practice Address - Phone:760-403-0573
Practice Address - Fax:760-318-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15946-0Medicare ID - Type Unspecified