Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
SHANE BUSH, PH.D.
Active Sole ProprietorClinical Neuropsychologist · LAKE RONKONKOMA, NY
Registration Details
- NPI Number
- 1003868514
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 16, 2006 (19.932269932908 yrs)
- Last Updated
- Jul 18, 2007
- Licenses
-
012998-2 (NY)012998 (NY)012998 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
290 HAWKINS AVESUITE BLAKE RONKONKOMA, NY, 117799600Browse NY providers · Browse ZIP 11779
- Phone
- 6313347884
- Fax
- 6319803715
- Primary Specialty
-
Clinical Neuropsychologist
103G00000X
- Additional Specialty
- Clinical Neuropsychologist
- Additional Specialty
- Rehabilitation Psychologist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.