Provider Demographics
NPI:1093531568
Name:DZIYA, SHELTER (PHD)
Entity type:Individual
Prefix:
First Name:SHELTER
Middle Name:
Last Name:DZIYA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EDEN WAY N STE 109
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:757-785-5540
Mailing Address - Fax:
Practice Address - Street 1:1216 IVYSTONE WAY APT 204
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7675
Practice Address - Country:US
Practice Address - Phone:561-808-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical