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General NPI Number Information
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NPI Number | 1699737940
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Entity Type | Individual
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Provider Name | PAUL BRYAN SHAGOURY PHD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 36 CLINTON ST D UNIT
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City | CONCORD
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State | NH
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Zip | 03301-2359
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Country | US
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Telephone | 603-271-5487
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SHARON DR
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City | BOW
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State | NH
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Zip | 03304-4324
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Country | US
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Telephone | 603-228-8232
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Fax | 603-668-8666
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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 | 150
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License Number State | NH
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