Healthcare Provider Details

I. General information

NPI: 1881378057
Provider Name (Legal Business Name): SHIVANTI SINGH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N ST STE N
SACRAMENTO CA
95816
US

IV. Provider business mailing address

2801 N ST STE N
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 909-619-3478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39340
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: