Individual
TIFFANY MARIE SHADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4100 HORIZONS DR., STE 202, OFFICE 203, COLUMBUS, OH 43220
(614) 355-8160
(614) 355-8180
Mailing address
4100 HORIZONS DR., STE 202, OFFICE 203, COLUMBUS, OH 43220-5280
(714) 357-7810
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
32997
CA
103T00000X
Psychologist
Primary
P.08452
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846675
—
OH
Enumeration date
08/25/2014
Last updated
09/25/2023
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