Provider Demographics
NPI:1053562272
Name:MANUEL-SHAH, CYNTHIA (MA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MANUEL-SHAH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LOS GATOS SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5310
Mailing Address - Country:US
Mailing Address - Phone:408-800-6415
Mailing Address - Fax:
Practice Address - Street 1:305 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5310
Practice Address - Country:US
Practice Address - Phone:408-800-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist