Provider Demographics
NPI:1609008440
Name:BUSUIOC, SHANNEL (MA)
Entity Type:Individual
Prefix:
First Name:SHANNEL
Middle Name:
Last Name:BUSUIOC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2115
Mailing Address - Country:US
Mailing Address - Phone:415-683-1203
Mailing Address - Fax:
Practice Address - Street 1:1122 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2115
Practice Address - Country:US
Practice Address - Phone:415-683-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health