Healthcare Provider Details

I. General information

NPI: 1841140720
Provider Name (Legal Business Name): SHASTYN S REID LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 GOULANT LN
REDDING CA
96002-9010
US

IV. Provider business mailing address

3156 GOULANT LN
REDDING CA
96002-9010
US

V. Phone/Fax

Practice location:
  • Phone: 530-355-8288
  • Fax:
Mailing address:
  • Phone: 530-355-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: