| Adena Shoshan Psyd Pc | |
|
441 Penbrooke Dr Ste 1 Penfield NY 14526-2046 | |
| (585) 454-9904 | |
| (585) 286-4487 |
| Full Name | Adena Shoshan Psyd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 441 Penbrooke Dr Ste 1, Penfield, New York |
| Authorized Official Name and Position | Adena Shoshan (PRESIDENT/OWNER) |
| Authorized Official Contact | 5854549904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adena Shoshan Psyd Pc 441 Penbrooke Dr Ste 1 Penfield NY 14526-2046 Ph: (585) 454-9904 | Adena Shoshan Psyd Pc 441 Penbrooke Dr Ste 1 Penfield NY 14526-2046 Ph: (585) 454-9904 |
| NPI Number | 1821500174 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 10/26/2017 |
| Medicare PECOS PAC ID | 9335408756 |
|---|---|
| Medicare Enrollment ID | O20180110002727 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821500174 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 019295 (New York) | Primary |
| Provider Name | Adena E Shoshan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407103252 PECOS PAC ID: 0143580969 Enrollment ID: I20180215001989 |
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