Provider Demographics
NPI:1659443109
Name:SHEFRIN, RUSSELL N (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:N
Last Name:SHEFRIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ALBERTA DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-837-6705
Mailing Address - Fax:716-837-6759
Practice Address - Street 1:3065 SOUTHWESTERN BOULEVARD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-675-9232
Practice Address - Fax:716-675-9217
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00020913401OtherUNIVERA
000507516005OtherBLUE CROSS
61 01039OtherINDEPENDENT HEALTH
000507516005OtherBLUE CROSS
CC2895Medicare ID - Type Unspecified