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General NPI Number Information
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NPI Number | 1972329993
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Entity Type | Individual
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Provider Name | SHANA PRYOR PHD
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1145 STURGIS RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92278
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Country | US
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Telephone | 937-570-8428
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 482 BOX 2515
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City | FPO
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State | AP
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Zip | 96362-0026
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008707
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License Number State | VA
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