Healthcare Provider Details

I. General information

NPI: 1679419725
Provider Name (Legal Business Name): MS. SHAY ANDREA CAMPANELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TEMPLE AVE
BEAUMONT CA
92223-3154
US

IV. Provider business mailing address

35912 AVENUE H
YUCAIPA CA
92399-5206
US

V. Phone/Fax

Practice location:
  • Phone: 951-452-6218
  • Fax:
Mailing address:
  • Phone: 909-790-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: