Provider Demographics
NPI:1285989087
Name:SHEWBARRAN, CHRISTOPHER TARACHAND (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TARACHAND
Last Name:SHEWBARRAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 N HUALAPAI WAY
Mailing Address - Street 2:SUITE 145, #229
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149
Mailing Address - Country:US
Mailing Address - Phone:702-900-1041
Mailing Address - Fax:
Practice Address - Street 1:6720 N HUALAPAI WAY
Practice Address - Street 2:SUITE 145, #229
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-900-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY1022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8121Medicaid