Healthcare Provider Details

I. General information

NPI: 1013943802
Provider Name (Legal Business Name): BRIAN VINCENT SHENAL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD SALEM VAMC - MENTAL HEALTH (116B)
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BLVD SALEM VAMC - MENTAL HEALTH (116B)
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-983-1085
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-983-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003943
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003943
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB030116102
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: