Provider Demographics
NPI:1629441894
Name:KUSHNIR, SHARONE SHMUEL DAVID (PSY D, LP)
Entity Type:Individual
Prefix:DR
First Name:SHARONE
Middle Name:SHMUEL DAVID
Last Name:KUSHNIR
Suffix:
Gender:M
Credentials:PSY D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E HALLANDALE BEACH BLVD STE 15-719
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4478
Mailing Address - Country:US
Mailing Address - Phone:310-709-4966
Mailing Address - Fax:
Practice Address - Street 1:1025 E HALLANDALE BEACH BLVD STE 15-719
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4478
Practice Address - Country:US
Practice Address - Phone:305-676-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11384103G00000X, 103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty