Healthcare Provider Details

I. General information

NPI: 1992349807
Provider Name (Legal Business Name): GEA DAIANA SHANDA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY PKWY W
ORANGE CA
92868-2941
US

IV. Provider business mailing address

500 CITY PKWY W
ORANGE CA
92868-2941
US

V. Phone/Fax

Practice location:
  • Phone: 562-304-8144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: