Healthcare Provider Details

I. General information

NPI: 1770946402
Provider Name (Legal Business Name): SHAYAN RAD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

IV. Provider business mailing address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-0340
  • Fax:
Mailing address:
  • Phone: 818-240-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: