Provider Demographics
NPI:1366798050
Name:SHAMOS, IRNA LYNN (PHD ABPP)
Entity type:Individual
Prefix:DR
First Name:IRNA
Middle Name:LYNN
Last Name:SHAMOS
Suffix:
Gender:F
Credentials:PHD ABPP
Other - Prefix:DR
Other - First Name:IRNA
Other - Middle Name:LYNN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4516 EAST ONYX AVENUE
Mailing Address - Street 2:ARIZONA PSYCHOLOGICAL DIAGNOSTICS, PLC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:480-664-9122
Mailing Address - Fax:480-951-2355
Practice Address - Street 1:4516 EAST ONYX AVENUE
Practice Address - Street 2:ARIZONA PSYCHOLOGICAL DIAGNOSTICS, PLC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-664-9122
Practice Address - Fax:480-951-2355
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2082103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist