Healthcare Provider Details

I. General information

NPI: 1861338311
Provider Name (Legal Business Name): MRS. SHAYNA ELIZABETH GILLERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22122 SHERMAN WAY STE 105
CANOGA PARK CA
91303-1159
US

IV. Provider business mailing address

22122 SHERMAN WAY STE 105
CANOGA PARK CA
91303-1159
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-2787
  • Fax:
Mailing address:
  • Phone: 877-407-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: