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General NPI Number Information
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NPI Number | 1659443109
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Entity Type | Individual
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Provider Name | RUSSELL N SHEFRIN PHD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3065 SOUTHWESTERN BOULEVARD SUITE 204
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City | ORCHARD PARK
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State | NY
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Zip | 14127
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Country | US
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Telephone | 716-675-9232
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Fax | 716-675-9217
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Provider Business Mailing Address
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Address Line | 315 ALBERTA DRIVE SUITE 211
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City | AMHERST
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State | NY
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Zip | 14226
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Country | US
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Telephone | 716-837-6705
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Fax | 716-837-6759
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 005774
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License Number State | NY
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