Healthcare Provider Details

I. General information

NPI: 1750044962
Provider Name (Legal Business Name): SHELBY RENEE PISHNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date: 06/15/2022
Reactivation Date: 07/19/2022

III. Provider practice location address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

IV. Provider business mailing address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-4920
  • Fax: 626-974-8198
Mailing address:
  • Phone: 626-858-4920
  • Fax: 626-974-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: