Healthcare Provider Details

I. General information

NPI: 1700081692
Provider Name (Legal Business Name): VICTOR JOSEPH SHKLYAREVSKY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LEOPARD RD PAOLI EXECUTIVE GREEN I, SUITE 304
PAOLI PA
19301-1549
US

IV. Provider business mailing address

35 SANDY LN
MALVERN PA
19355-3027
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-6406
  • Fax: 610-407-0302
Mailing address:
  • Phone: 610-651-0551
  • Fax: 610-651-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008850L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: