Susie Shin-Calandrella, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

A92898 Issued in CA

Practice address

365 Kuck LN
Petaluma, CA 94952-9606

Phone

(707) 806-9393

NPI assigned

Nov 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1790859775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 LAKEVILLE ST # 146",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 KUCK LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949529606",
            "telephone_number": "707-806-9393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W Carson St",
            "address_2": "Box 498",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022004",
            "country_code": "US",
            "telephone_number": "310-222-3178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN-CALANDRELLA",
        "first_name": "SUSIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A92898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristal Shelden, R.D.
• Adam D. Shemper, M.A.
• Michaela Shepphard, M.D.
• Sherian L Prince
• Sonya Shiffer, M.ED., BCBA
• Dane Arthur Shoemaker, N.P.
• Samantha Shoemaker
• Richard A Shoninger
• Amy Shouse, LAC
• Diane Elizabeth Shrock, LMFT

• Child & Adolescent Psychiatry Physician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.