Provider Demographics
NPI:1255980017
Name:CLAY, SHAWNDELL KALISHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWNDELL
Middle Name:KALISHA
Last Name:CLAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 ARPEGGIO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2303
Mailing Address - Country:US
Mailing Address - Phone:408-623-5509
Mailing Address - Fax:
Practice Address - Street 1:925 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1431
Practice Address - Country:US
Practice Address - Phone:650-521-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical