Provider Demographics
NPI:1457887895
Name:KASSAI, SHABNAM SASHA (PSYD)
Entity Type:Individual
Prefix:
First Name:SHABNAM
Middle Name:SASHA
Last Name:KASSAI
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 1:3406 VIA LIDO STE 1A377
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3961
Mailing Address - Country:US
Mailing Address - Phone:310-985-5846
Mailing Address - Fax:
Practice Address - Street 1:3406 VIA LIDO STE 1A377
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3961
Practice Address - Country:US
Practice Address - Phone:310-985-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY33101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program