Provider Demographics
NPI:1932942638
Name:CHHANA, SHIETEL
Entity type:Individual
Prefix:DR
First Name:SHIETEL
Middle Name:
Last Name:CHHANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 WHITNEY VISTA LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2468
Mailing Address - Country:US
Mailing Address - Phone:678-895-1794
Mailing Address - Fax:
Practice Address - Street 1:4014 WHITNEY VISTA LN
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2468
Practice Address - Country:US
Practice Address - Phone:678-895-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3681103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool