Healthcare Provider Details

I. General information

NPI: 1780010314
Provider Name (Legal Business Name): MRS. MAYTAL SHALEV-EYLATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FREMONT AVE STE 140
LOS ALTOS CA
94024-6009
US

IV. Provider business mailing address

880 HOFFMAN TER
LOS ALTOS CA
94024-6614
US

V. Phone/Fax

Practice location:
  • Phone: 650-283-3701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: