Provider Demographics
NPI:1730989393
Name:SHUNGUSA, DAVID BUKURU
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BUKURU
Last Name:SHUNGUSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W HANCOCK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4849
Mailing Address - Country:US
Mailing Address - Phone:702-807-9790
Mailing Address - Fax:702-807-9790
Practice Address - Street 1:274 W HANCOCK ST APT 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4849
Practice Address - Country:US
Practice Address - Phone:702-807-9790
Practice Address - Fax:702-807-9790
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health