Provider Demographics
NPI:1992185565
Name:MULDER, SHAMBRA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAMBRA
Middle Name:
Last Name:MULDER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 JENNA RST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8878
Mailing Address - Country:US
Mailing Address - Phone:859-229-6823
Mailing Address - Fax:
Practice Address - Street 1:1500 LEESTOWN RD
Practice Address - Street 2:STE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2045
Practice Address - Country:US
Practice Address - Phone:859-229-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist