Provider Demographics
NPI:1982036984
Name:DPHREPAULEZZ, SHINO
Entity Type:Individual
Prefix:
First Name:SHINO
Middle Name:
Last Name:DPHREPAULEZZ
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 1:3780 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1629
Mailing Address - Country:US
Mailing Address - Phone:510-326-3446
Mailing Address - Fax:
Practice Address - Street 1:2545 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1121
Practice Address - Country:US
Practice Address - Phone:510-446-7195
Practice Address - Fax:510-446-7188
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)