Healthcare Provider Details

I. General information

NPI: 1679180764
Provider Name (Legal Business Name): SHAUNA AMADORE PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DOVE ST STE 260
NEWPORT BEACH CA
92660-2803
US

IV. Provider business mailing address

1101 DOVE ST STE 260
NEWPORT BEACH CA
92660-2803
US

V. Phone/Fax

Practice location:
  • Phone: 949-939-0242
  • Fax:
Mailing address:
  • Phone: 949-939-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: