MEDICARE: DR. SHUPING LIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TE1100X	Exercise & Sports Psychologist	017918-1	NY
2	103TC1900X	Counseling Psychologist	017918-1	NY

General Provider Information

NPI Number	:	1043830607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHUPING LIN PH.D.

Provider Business Mailing Address
First Line	:	2764 DALE AVE
Second Line	:
City	:	BEXLEY
State	:	OH
Zip	:	43209-1811
Country	:	US
Telephone Number	:	614-966-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	987 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2527
Country	:	US
Telephone Number	:	614-468-8184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	04/23/2020

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Directions to “ DR. SHUPING LIN PH.D.” Practice Location

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