Provider Demographics
NPI:1063720779
Name:SHAVALIER, LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:SHAVALIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:OBERTEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3807 WRIGHTSVILLE AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8463
Mailing Address - Country:US
Mailing Address - Phone:910-418-1653
Mailing Address - Fax:910-218-8347
Practice Address - Street 1:3807 WRIGHTSVILLE AVE STE 21
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8463
Practice Address - Country:US
Practice Address - Phone:716-725-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01773103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist