Healthcare Provider Details

I. General information

NPI: 1609535087
Provider Name (Legal Business Name): SHANLEY NEWMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21151 S WESTERN AVE STE 273
TORRANCE CA
90501-1724
US

IV. Provider business mailing address

21151 S WESTERN AVE STE 273
TORRANCE CA
90501-1724
US

V. Phone/Fax

Practice location:
  • Phone: 323-591-9611
  • Fax:
Mailing address:
  • Phone: 323-591-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94026387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: