Healthcare Provider Details

I. General information

NPI: 1023748860
Provider Name (Legal Business Name): SHREYA LAKHAN-PAL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 POWER INN RD STE 140
SACRAMENTO CA
95826-3889
US

IV. Provider business mailing address

26855 DEZAHARA WAY
LOS ALTOS HILLS CA
94022-4376
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1183
  • Fax:
Mailing address:
  • Phone: 650-492-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35346
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: