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SHANE BUSH PH.D.
NPI 1003868514
Clinical Neuropsychologist in Lake Ronkonkoma, NY

Active since May 16, 2006Opted out of Medicare · through Dec 8, 2026
290 HAWKINS AVE, SUITE B, LAKE RONKONKOMA, NY 11779(631) 334-7884(631) 980-3715 Get Directions Write a Review

NPPES record last updated: July 18, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shane Bush Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE BUSH PH.D. (NPI 1003868514) is an individual clinical neuropsychologist in Lake Ronkonkoma, New York, licensed in New York (012998) and active in the NPI registry since May 2006. He has opted out of Medicare through December 8, 2026.

NPPES Registry Identity

NPI1003868514
Entity TypeIndividualMale
Primary Taxonomy103G00000X
Provider Legal NameSHANE BUSHCredential: PH.D.
Location Address290 HAWKINS AVE, SUITE BLake Ronkonkoma, NY 11779-9600
Mailing Address290 Hawkins Ave, Suite BLake Ronkonkoma, NY 11779-9600 · (631) 334-7884 · Fax (631) 980-3715
Phone(631) 334-7884
Fax(631) 980-3715
Sole ProprietorYes
Enumeration DateMay 16, 2006
Last NPPES UpdateJuly 18, 2007
✔ NPI 1003868514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in NY · 012998
Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 012998-2 (NY)
Also ListedPsychologist · RehabilitationTaxonomy 103TR0400X · License 012998 (NY)
290 HAWKINS AVE, Lake Ronkonkoma, NY 11779
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Shane Bush Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 8, 2024 through December 8, 2026.

Opt-Out Effective DateDecember 8, 2024
Opt-Out In Effect ThroughDecember 8, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DANA G. BUSH PH.D.
Psychologist (Clinical)
290 HAWKINS AVE, STE. B
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 431-1581
LONG ISLAND NEUROPSYCHOLOGY, P.C.
Psychologist (Forensic)
290 HAWKINS AVE, SUITE B
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 334-7884
MICHAEL CRETA, DO
Family Medicine
290 HAWKINS AVE
LAKE RONKONKOMA, NY 11779
Suffolk County (631) 981-0045

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Bush's NPI number?

The NPI number for Shane Bush is 1003868514. It was assigned to this individual provider in the NPPES registry on May 16, 2006.

Where is Shane Bush located?

Shane Bush practices at 290 Hawkins Ave Suite B, Lake Ronkonkoma, NY 11779. The listed phone number is (631) 334-7884.

What is Shane Bush's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Shane Bush enrolled in Medicare?

No. Shane Bush has opted out of Medicare through December 8, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Shane Bush was last updated on July 18, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.