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General NPI Number Information
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NPI Number | 1366798050
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Entity Type | Individual
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Provider Name | IRNA LYNN SHAMOS PH.D. ABPP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 4516 EAST ONYX AVENUE ARIZONA PSYCHOLOGICAL DIAGNOSTICS, PLC
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City | PHOENIX
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State | AZ
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Zip | 85028
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Country | US
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Telephone | 480-664-9122
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Fax | 480-951-2355
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Provider Business Mailing Address
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Address Line | 4516 EAST ONYX AVENUE ARIZONA PSYCHOLOGICAL DIAGNOSTICS, PLC
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City | PHOENIX
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State | AZ
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Zip | 85028
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Country | US
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Telephone | 480-664-9122
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Fax | 480-951-2355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2082
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License Number State | AZ
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