Provider Demographics
NPI:1831218791
Name:BUDER SHAPIRO, JANE R (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:R
Last Name:BUDER SHAPIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3351 INGLESIDE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3417
Mailing Address - Country:US
Mailing Address - Phone:440-734-8131
Mailing Address - Fax:216-595-0118
Practice Address - Street 1:23210 CHAGRIN BLVD STE 211
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5425
Practice Address - Country:US
Practice Address - Phone:440-734-8131
Practice Address - Fax:216-595-0118
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4945103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist