DR. SHAN PSYCHIATRY CLINIC LLC (NPI# 1861637381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861637381 |
| Entity Type | Organization |
| Organization Name | DR. SHAN PSYCHIATRY CLINIC LLC |
| Practice Address |
756 Adams Ave Philadelphia PA 19124-2330 |
| Practice Telephone | 2155333660 |
| Practice Fax Number | 2155333682 |
| Mailing Telephone | 2155333660 |
| Mailing Fax Number | 2155333682 |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2008-12-12 |
| Authorized Official Name | YANG SHAN (DIRECTOR) |
| Authorized Official Telephone | 2155333660 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | MD421627 | PA | Behavioral Health & Social Service Providers |
| Street Address |
756 ADAMS AVE |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-2330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205359445 | Ying Shan | Counselor | 756 Adams Ave, Philadelphia, PA 19124-2330 | 2017-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831749308 | William Mark Hanna Sr. | Pharmacist | 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 | 2019-09-17 |
| 1881256451 | Medical Discovery Systems, LLC | Durable Medical Equipment & Medical Supplies | 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 | 2019-07-03 |
| 1548731391 | Sierra Pinkney | Registered Nurse | 1615 Granite St, Philadelphia, PA 19124 | 2018-12-05 |
| 1922507987 | Xavier Sergio Henriquez | Counselor | 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 | 2018-02-06 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1952843732 | Patrick Grugan | Social Worker | Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 | 2016-11-10 |
| 1811340482 | Katarzyna Liwski | Psychiatry & Neurology | 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 | 2016-07-19 |
| 1851769327 | Aleka Kostouros | Social Worker | Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 | 2015-09-14 |
| 1407230378 | Sara Bachani | Psychiatry & Neurology | 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 | 2015-07-10 |
| 1215327051 | Alyssa Renee Kirk | Counselor | 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 | 2015-02-02 |
| Find all providers in zip 19124 | ||||
| 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 |
|---|---|---|---|---|
| 1467092312 | Katie Fabius | Clinical Neuropsychologist | 230 S Broad St Ste 1005, Philadelphia, PA 19102-4105 | 2020-01-08 |
| 1609228022 | Michael E. Keesler | Clinical Neuropsychologist | 77 Rochelle Ave, Philadelphia, PA 19128-3809 | 2016-07-09 |
| 1023463106 | Chelsea Black | Clinical Neuropsychologist | 3405 Civic Center Blvd Rm 107, Philadelphia, PA 19104-4319 | 2016-04-26 |
| 1285088914 | Megan Alana Perrin | Clinical Neuropsychologist | 1510 Manton St, Philadelphia, PA 19146-3129 | 2016-04-19 |
| 1104207190 | Kelly M. Janke | Clinical Neuropsychologist | 3501 Civic Center Blvd # 10209, Philadelphia, PA 19104-3820 | 2015-06-15 |
| 1225184468 | Cornelius Furgueson | Clinical Neuropsychologist | 1801 Vine St, Room 149-mg, Philadelphia, PA 19103-1117 | 2007-01-27 |
| 1588711006 | Diversified Psychological Resources, P.C. | Clinical Neuropsychologist | 230 S. Broad St., Suite 1005, Philadelphia, PA 19102-4105 | 2007-01-05 |
| 1407879430 | Carol L Armstrong | Clinical Neuropsychologist | 100 N 20th St, Philadelphia, PA 19103-1443 | 2006-07-25 |
| 1558381251 | Edward A Maitz | Clinical Neuropsychologist | 117 S 17th St, Suite 1700, Philadelphia, PA 19103-5025 | 2006-07-19 |
| 1558380766 | Agnieszka A Kleczek | Clinical Neuropsychologist | 4621 Salmon St, Philadelphia, PA 19137-2123 | 2006-07-19 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
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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.