MEDICARE: WILLIAM SHANNON VAN WEY PHD

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	808	NC
2	103TC0700X	Clinical Psychologist	808	NC

General Provider Information

NPI Number	:	1669409900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SHANNON VAN WEY PHD

Provider Business Mailing Address
First Line	:	115 NORTH DUKE STREET
Second Line	:	SUITE 1-B
City	:	DURHAM
State	:	NC
Zip	:	27701-2010
Country	:	US
Telephone Number	:	919-286-3453
Fax Number	:	919-286-7033

Provider Business Practice Location Address
First Line	:	115 NORTH DUKE STREET
Second Line	:	SUITE 1-B
City	:	DURHAM
State	:	NC
Zip	:	27701-2010
Country	:	US
Telephone Number	:	919-286-3453
Fax Number	:	919-286-7033

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/13/2010

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