Provider Demographics
NPI:1376573493
Name:SHUSTA-HOCHBERG, SHIELAGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIELAGH
Middle Name:
Last Name:SHUSTA-HOCHBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 UNIVERSITY PL
Mailing Address - Street 2:10TH FLOOR, SUITE 1009
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4527
Mailing Address - Country:US
Mailing Address - Phone:212-777-0775
Mailing Address - Fax:
Practice Address - Street 1:113 UNIVERSITY PL
Practice Address - Street 2:10TH FLOOR, SUITE 1009
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4527
Practice Address - Country:US
Practice Address - Phone:212-777-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012607-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP984095OtherOXFORD- CLINICAL PSYCHOLO
NY01622233Medicaid
NY01622233Medicaid