Provider Demographics
NPI:1114909603
Name:SHOCKET, SUANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUANNE
Middle Name:
Last Name:SHOCKET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 SURVEYOR CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4422
Mailing Address - Country:US
Mailing Address - Phone:703-330-1072
Mailing Address - Fax:703-330-3966
Practice Address - Street 1:9625 SURVEYOR CT
Practice Address - Street 2:SUITE 210
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4422
Practice Address - Country:US
Practice Address - Phone:703-330-1072
Practice Address - Fax:703-330-3966
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6880000551Medicare ID - Type Unspecified