Provider Demographics
NPI:1851279582
Name:EVELYN, SHAWN CHANTAL (PMHNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CHANTAL
Last Name:EVELYN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:CHANTAL
Other - Last Name:EVELYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9302 SUMMERTIME LN
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4562
Mailing Address - Country:US
Mailing Address - Phone:323-819-6811
Mailing Address - Fax:
Practice Address - Street 1:9302 SUMMERTIME LN
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4562
Practice Address - Country:US
Practice Address - Phone:323-819-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95036448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health