Provider Demographics
NPI:1003267329
Name:SHIMAOKA, JUNICHI
Entity Type:Individual
Prefix:
First Name:JUNICHI
Middle Name:
Last Name:SHIMAOKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 PACKARD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3816
Mailing Address - Country:US
Mailing Address - Phone:408-475-8739
Mailing Address - Fax:
Practice Address - Street 1:1316 PACKARD ST APT 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3816
Practice Address - Country:US
Practice Address - Phone:408-475-8739
Practice Address - Fax:734-763-0454
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist