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General NPI Number Information
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NPI Number | 1780646729
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Entity Type | Individual
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Provider Name | SHANNON RENEE WHYTE PHD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4715 VIEWRIDGE AVE STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92123-1680
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Country | US
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Telephone | 800-257-8715
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 KINGSTON DR
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City | RICHARDSON
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State | TX
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Zip | 75082-4003
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Country | US
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Telephone | 972-480-0663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32532
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License Number State | TX
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