Healthcare Provider Details

I. General information

NPI: 1609793439
Provider Name (Legal Business Name): DARYA ARTYOMOVNA SHLEYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DASHA ARTYOMOVNA SHLEYEVA

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 NE SANDY BLVD STE 270
PORTLAND OR
97232-2791
US

IV. Provider business mailing address

3623 N BORTHWICK AVE
PORTLAND OR
97227-1218
US

V. Phone/Fax

Practice location:
  • Phone: 971-940-2601
  • Fax:
Mailing address:
  • Phone: 714-293-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: