MEDICARE: SHIRAN ASULIN

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	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386052454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRAN ASULIN

Provider Business Mailing Address
First Line	:	1111 ELM ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-1782
Country	:	US
Telephone Number	:	413-734-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W DUNLAP AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-2813
Country	:	US
Telephone Number	:	480-372-2130
Fax Number	:

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

Provider Enumeration Date	:	08/01/2014
Last Update Date	:	09/26/2018

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Directions to “ SHIRAN ASULIN ” Practice Location

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