Provider Demographics
NPI:1457402984
Name:SHEHAB, DENA LIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:LIANE
Last Name:SHEHAB
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 1:2244 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3803
Mailing Address - Country:US
Mailing Address - Phone:503-709-8503
Mailing Address - Fax:
Practice Address - Street 1:1308 NW 20TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1607
Practice Address - Country:US
Practice Address - Phone:503-709-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ9110 01OtherPACIFICSOURCE PROVIDER #