Provider Demographics
NPI:1356048219
Name:SHANKAR, SHRUTI (MAP, MA AMFT)
Entity type:Individual
Prefix:MS
First Name:SHRUTI
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:MAP, MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 6TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1415
Mailing Address - Country:US
Mailing Address - Phone:424-341-5193
Mailing Address - Fax:
Practice Address - Street 1:934 HERMOSA AVE STE 11
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4122
Practice Address - Country:US
Practice Address - Phone:310-957-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy