Healthcare Provider Details

I. General information

NPI: 1457559569
Provider Name (Legal Business Name): WANA SHIRGUL SALEHI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 FAIRWAY DR
SAN LEANDRO CA
94577-5411
US

IV. Provider business mailing address

2411 SAYBROOK PL
MARTINEZ CA
94553-6710
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 510-673-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: