Provider Demographics
NPI:1760636781
Name:SHULMAN, TRYSA (PSYD)
Entity Type:Individual
Prefix:
First Name:TRYSA
Middle Name:
Last Name:SHULMAN
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 1:6700 BETA DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2368
Mailing Address - Country:US
Mailing Address - Phone:440-446-9696
Mailing Address - Fax:440-449-1435
Practice Address - Street 1:6700 BETA DR STE 301
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2368
Practice Address - Country:US
Practice Address - Phone:440-446-9696
Practice Address - Fax:440-449-1435
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical