Bush, Shane

Bush, Shane is an sole proprietor health care provider with primary practice located at 290 Hawkins Ave Suite B, Lake Ronkonkoma NY 11779-9600. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Rehabilitation. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Bush, Shane can be contacted via phone (631) 334-7884.

Contact Information

Primary practice address
290 Hawkins Ave Suite B Lake Ronkonkoma NY 11779-9600
Phone: (631) 334-7884
Fax: (631) 980-3715
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 012998-2 New York
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 012998 New York
Behavioral Health & Social Service Providers / Rehabilitation 103TR0400X 012998 New York

Profile Details

NPI number 1003868514
LBN Legal business name Bush, Shane
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 16th, 2006
Last updated Jul 18th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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