NPI 1003868514

Shane Bush, PHD

Practitioner Clinical Neuropsychologist Lake Ronkonkoma, NY

Practice location

Address: 290 Hawkins Ave Suite B, Lake Ronkonkoma, NY 11779-9600
Phone: (631) 334-7884
Fax: (631) 980-3715

Registered specialties (3)

Clinical Neuropsychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103G00000X Licence 012998 (NY)

Other Clinical Neuropsychologist providers in New York →

Clinical Psychologist

Behavioral Health & Social Service Providers Taxonomy 103TC0700X Licence 012998-2 (NY)

Other Psychologist providers in New York →

Rehabilitation Psychologist

Behavioral Health & Social Service Providers Taxonomy 103TR0400X Licence 012998 (NY)

Registry record

NPI: 1003868514
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 May 2006
Record last updated: 18 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.