Provider Demographics
NPI:1023078771
Name:SHYBUNKO, DANIEL E (PHD,)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:SHYBUNKO
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:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1068
Mailing Address - Country:US
Mailing Address - Phone:540-464-3003
Mailing Address - Fax:540-464-3181
Practice Address - Street 1:108 HOUSTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2455
Practice Address - Country:US
Practice Address - Phone:540-464-3003
Practice Address - Fax:540-464-3181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA030528OtherVALUE OPTIONS
VA086151OtherSENTARA HEALTH
VA541777975OtherCHAMPUS
VA260177OtherANTHEM BLUE CROSS OF VA
VA007754035Medicaid
VA086151OtherSOUTHERN HEALTH SERVICES
VA254526000OtherMAGELLAN
VA28051OtherVIRGINIA PREMIER
VA086151OtherSOUTHERN HEALTH SERVICES