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NPI Code Detail

MEDICARE: DR. DENA LIANE SHEHAB PSY.D.

MEDICARE: DR. DENA LIANE SHEHAB PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1746OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J9110 01OTHERORPACIFICSOURCE PROVIDER #

General Provider Information

NPI Number : 1457402984
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENA LIANE SHEHAB PSY.D.
Provider Business Mailing Address
First Line : 2244 NE 8TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-3803
Country : US
Telephone Number : 503-709-8503
Fax Number :
Provider Business Practice Location Address
First Line : 1308 NW 20TH AVE
Second Line : SUITE 12
City : PORTLAND
State : OR
Zip : 97209-1607
Country : US
Telephone Number : 503-709-8503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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