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NPI Code Detail

MEDICARE: SHYANN MIKAELL CAMPANA M.A.

MEDICARE: SHYANN MIKAELL CAMPANA M.A.
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
1103T00000XPsychologistA6CA
2390200000XStudent in an Organized Health Care Education/Training Program
3103T00000XPsychologist38721TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
138721OTHERTXLICENSED PSYCHOLOGIST NUMBER

General Provider Information

NPI Number : 1831618784
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHYANN MIKAELL CAMPANA M.A.
Provider Business Mailing Address
First Line : 8350 N CENTRAL EXPY STE 1275
Second Line :
City : DALLAS
State : TX
Zip : 75206-1614
Country : US
Telephone Number : 469-232-7965
Fax Number :
Provider Business Practice Location Address
First Line : 8350 N CENTRAL EXPY STE 1275
Second Line :
City : DALLAS
State : TX
Zip : 75206-1614
Country : US
Telephone Number : 469-232-7965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2017
Last Update Date : 04/14/2022

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