Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | PY5644 | FL |
NPI | 1417287285 |
---|---|
Provider Name | Michael Shahnasarian |
First Address | Tampa, FL 33618-3801 |
Second Address | Tampa, FL 33618-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2009 |
Last Update Date | 30/12/2009 |