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NPI Code Detail

MEDICARE: MOSHE SHTUHL PH.D.

MEDICARE:   MOSHE  SHTUHL  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist0810002082VA

General Provider Information

NPI Number : 1114122983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOSHE SHTUHL PH.D.
Provider Business Mailing Address
First Line : 11150 SUNSET HILLS RD STE 150
Second Line :
City : RESTON
State : VA
Zip : 20190-5325
Country : US
Telephone Number : 703-471-5517
Fax Number : 703-481-8197
Provider Business Practice Location Address
First Line : 11150 SUNSET HILLS RD STE 150
Second Line :
City : RESTON
State : VA
Zip : 20190-5325
Country : US
Telephone Number : 703-471-5517
Fax Number : 703-481-8197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 07/08/2007

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