MEDICARE: DR. AMY B GONSHAK 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1316226590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY B GONSHAK PH.D.

Provider Business Mailing Address
First Line	:	4031 FIRESTONE WAY
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-6305
Country	:	US
Telephone Number	:	502-523-1863
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 FIRESTONE WAY
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-6305
Country	:	US
Telephone Number	:	502-523-1863
Fax Number	:

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

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	02/20/2026

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