MEDICARE: DR. JANINE SHELBY PH.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
1	103T00000X	Psychologist	PSY15429	CA
2	103TC0700X	Clinical Psychologist	15429	CA

General Provider Information

NPI Number	:	1760532782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANINE SHELBY PH.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8807
Fax Number	:	310-301-8751

Provider Business Practice Location Address
First Line	:	760 WESTWOOD PLZ # 48-240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5055
Country	:	US
Telephone Number	:	310-222-3121
Fax Number	:	310-267-1908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/08/2024

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