Provider Demographics
NPI:1013943802
Name:SHENAL, BRIAN VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:VINCENT
Last Name:SHENAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:SALEM VAMC - MENTAL HEALTH (116B)
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1085
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:SALEM VAMC - MENTAL HEALTH (116B)
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1085
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810003943103TC0700X, 103G00000X
VAB030116102146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic