Individual
DR. SHANE SHACKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
325 E JIMMIE LEEDS RD, SUITE 182, GALLOWAY, NJ 08205-4126
(609) 325-8775
Mailing address
325 E JIMMIE LEEDS RD, SUITE 182, GALLOWAY, NJ 08205-4126
(609) 325-8775
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2516
NJ
Other
Enumeration date
10/29/2011
Last updated
10/29/2011
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