MEDICARE: DR. SUSANNE ROBIN SHULMAN 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
1	103TC0700X	Clinical Psychologist	014336-1	NY

General Provider Information

NPI Number	:	1215001326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNE ROBIN SHULMAN PH.D.

Provider Business Mailing Address
First Line	:	25 FLATBUSH AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1101
Country	:	US
Telephone Number	:	718-875-1420
Fax Number	:	718-875-5496

Provider Business Practice Location Address
First Line	:	25 FLATBUSH AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1101
Country	:	US
Telephone Number	:	718-875-1420
Fax Number	:	718-875-5496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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