MEDICARE: DR. SHANTRICE LASHAUN GIBSON PSY.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	103T00000X	Psychologist	795	NE
2	103T00000X	Psychologist	P.08675	OH

General Provider Information

NPI Number	:	1932362001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTRICE LASHAUN GIBSON PSY.D

Provider Business Mailing Address
First Line	:	47185 COOPER FOSTER PARK RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-3307
Country	:	US
Telephone Number	:	440-960-3954
Fax Number	:	440-960-3956

Provider Business Practice Location Address
First Line	:	47185 COOPER FOSTER PARK RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-3307
Country	:	US
Telephone Number	:	440-960-3954
Fax Number	:	440-960-3956

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	01/02/2026

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