=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083584197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL NEUROPSYCHOLOGY AND TREATMENT CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19606 COASTAL HWY
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-8596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-309-5048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 CROYDON RD
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | DR. SHAWNA SHOBNA VAN SCOYOC
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 202-309-5048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------