SHANE BUSH (NPI# 1003868514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003868514 |
| Entity Type | Individual |
| Full Name | SHANE BUSH |
| Credential | PH.D. |
| Practice Address |
290 Hawkins Ave Suite B Lake Ronkonkoma NY 11779-9600 |
| Practice Telephone | 6313347884 |
| Practice Fax Number | 6319803715 |
| Mailing Telephone | 6313347884 |
| Mailing Fax Number | 6319803715 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 012998 | NY | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
012998-2 | NY | Behavioral Health & Social Service Providers |
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
012998 | NY | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700896800 | Shane Allen Bush | Massage Therapist | 180 Nickerson St, Ste 103, Seattle, WA 98109-1631 | 2006-08-09 |
| 1316258874 | Shane David Bush | Family Medicine | 3630 Willowcreek Rd, Portage, IN 46368-5075 | 2010-06-29 |
| Street Address |
290 HAWKINS AVE SUITE B |
| City | LAKE RONKONKOMA |
| State | NY |
| Zip Code | 11779-9600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912024506 | Michael Creta, Do | Family Medicine | 290 Hawkins Ave, Lake Ronkonkoma, NY 11779-9600 | 2007-03-26 |
| 1174640668 | Dana G. Bush | Psychologist | 290 Hawkins Ave, Ste. B, Lake Ronkonkoma, NY 11779-9600 | 2007-03-22 |
| 1356467419 | Long Island Neuropsychology, P.C. | Clinical Neuropsychologist | 290 Hawkins Ave, Suite B, Lake Ronkonkoma, NY 11779-9600 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750929139 | Sebastian Godinez | Student in an Organized Health Care Education/Training Program | 11 First Street, Ronkonkoma, NY 11779 | 2019-12-16 |
| 1487149860 | John Deming | Student in an Organized Health Care Education/Training Program | 142 - 02 20th Avenue, Flushing, NY 11779 | 2018-06-27 |
| 1376060392 | Janine D'annunzio | Specialist | 316 Thirft Street, Ronkonkoma, NY 11779 | 2017-08-30 |
| 1932621935 | Vincent Joseph Lopreto | Counselor | 253 Lake Shore Road, Ronkonkoma, NY 11779 | 2017-07-11 |
| 1598295271 | Dalas Taddeo | Licensed Practical Nurse | 4490 Express Drive S, Ronkonkoma, NY 11779 | 2017-06-15 |
| 1790214112 | Pamela Ferrante | Social Worker | 131 Avenue D, Ronkonkoma, NY 11779 | 2017-06-08 |
| 1255868915 | Bari Home Care LLC | Health Maintenance Organization | 4417 Express Drive North, Ronkonkoma, NY 11779 | 2017-05-12 |
| 1013441328 | Caring Hands Home Care | Nursing Facility/Intermediate Care Facility | 65 Cheryl Drive, Ronkonkoma, NY 11779 | 2017-04-13 |
| 1831552025 | Jacqueline Galdamez | Social Worker | 979 Johnson Avenue, Ronkonkoma, NY 11779 | 2016-04-04 |
| 1891192530 | Alex Mitchell Pollack | Massage Therapist | 34 Richmond Blvd, #3a, Ronkonkoma, NY 11779 | 2014-11-24 |
| Find all providers in zip 11779 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356467419 | Long Island Neuropsychology, P.C. | Clinical Neuropsychologist | 290 Hawkins Ave, Suite B, Lake Ronkonkoma, NY 11779-9600 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609408046 | Nassau Neuropsychological Services, Pllc | Clinical Neuropsychologist | 386 S Oyster Bay Rd, Hicksville, NY 11801-3509 | 2020-02-04 |
| 1922656875 | Kouros Emami | Clinical Neuropsychologist | 525 East 71st St., 5th Floor, New York, NY 10021 | 2019-09-03 |
| 1720633860 | Emily Kurlansik | Clinical Neuropsychologist | 300 W 55th St Apt 6c, New York, NY 10019-5164 | 2019-08-06 |
| 1174181382 | Kayla Whearty | Clinical Neuropsychologist | 1554 Northern Blvd Ste 204, Manhasset, NY 11030-3054 | 2019-06-03 |
| 1447729595 | Beth Krone | Clinical Neuropsychologist | 6818 Bay Cliff Ter, Brooklyn, NY 11220-5114 | 2018-11-19 |
| 1750860144 | Linda Cristina Calderon | Clinical Neuropsychologist | 635 W 165th St Rm 633a, New York, NY 10032-3724 | 2018-08-07 |
| 1366936585 | Nicole Feirsen | Clinical Neuropsychologist | 3307 Bainbridge Ave Fl 1, Bronx, NY 10467-2850 | 2018-06-20 |
| 1306349493 | Abhishek Jaywant | Clinical Neuropsychologist | 525 E 68th St # F-1699g, New York, NY 10065-4870 | 2018-03-14 |
| 1043718505 | Elsa Lee | Clinical Neuropsychologist | 25418 Northern Blvd Ste 3, Little Neck, NY 11362-1451 | 2018-01-30 |
| 1154829000 | Alice Brown Brandwein | Clinical Neuropsychologist | 445 Park Ave Fl 2, New York, NY 10022-8649 | 2018-01-25 |
| Find all providers with the same taxonomy | ||||
| City | LAKE RONKONKOMA |
| Zip Code | 11779 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.