MEDICARE: SHIRLEY J LANYI PHD A PSYCHOLOGICAL CORP

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	103TA0700X	Adult Development & Aging Psychologist	PSY12078	CA

General Provider Information

NPI Number	:	1891014312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY J LANYI PHD A PSYCHOLOGICAL CORP

Provider Business Mailing Address
First Line	:	4700 SPRING ST
Second Line	:	STE 204
City	:	LA MESA
State	:	CA
Zip	:	91942-0263
Country	:	US
Telephone Number	:	619-908-6445
Fax Number	:	619-589-6840

Provider Business Practice Location Address
First Line	:	4700 SPRING ST
Second Line	:	STE 204
City	:	LA MESA
State	:	CA
Zip	:	91942-0263
Country	:	US
Telephone Number	:	619-908-6445
Fax Number	:	619-589-6840

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	STEPHANIE E SHELL
Credential	:
Telephone Number	:	760-295-2950

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	05/25/2010

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