Provider Demographics
NPI:1700058096
Name:SOOMAR, SHABANA (MS,PHD)
Entity Type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:
Last Name:SOOMAR
Suffix:
Gender:F
Credentials:MS,PHD
Other - Prefix:MS
Other - First Name:SHABANA
Other - Middle Name:
Other - Last Name:LAKHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PHD
Mailing Address - Street 1:701 GIBSON DR APT 314
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5737
Mailing Address - Country:US
Mailing Address - Phone:916-472-5031
Mailing Address - Fax:
Practice Address - Street 1:10423 OLD PLACERVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2540
Practice Address - Country:US
Practice Address - Phone:916-737-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30323103TC0700X
CAPSB-94021408390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program