Individual
DR. MICHAEL P. SHAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
12600 CREEKSIDE LN STE 7, FORT MYERS, FL 33919-3353
(239) 343-9220
(239) 343-9231
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9220
(239) 343-9231
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY8801
FL
103T00000X
Psychologist
PY8801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100323640A
—
IN
05
—
100323640D
—
IN
05
—
101839200
—
FL
01
—
680005356
MEDICARE RAILROAD
—
Enumeration date
08/19/2005
Last updated
02/27/2024
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