Provider Demographics
NPI:1063707800
Name:SHAMLOO, SHANA (PSYD)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:
Last Name:SHAMLOO
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 1:701 LACHMAN LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2804
Mailing Address - Country:US
Mailing Address - Phone:310-871-0255
Mailing Address - Fax:
Practice Address - Street 1:1247 7TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1643
Practice Address - Country:US
Practice Address - Phone:310-871-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program