=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508059122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA MARIE NESHEIM PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 08/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 SALINAS ST
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-757-7915
-----------------------------------------------------
Fax | 831-757-0762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 SALINAS ST
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-757-7915
-----------------------------------------------------
Fax | 831-757-0762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | PSY 18584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------