Healthcare Provider Details

I. General information

NPI: 1336739325
Provider Name (Legal Business Name): SHELBY NICHOLE RUBINO MAQMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MERIDIAN ST
NEWBERG OR
97132-2697
US

IV. Provider business mailing address

414 N MERIDIAN ST
NEWBERG OR
97132-2697
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-2390
  • Fax:
Mailing address:
  • Phone: 503-554-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4053
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: