Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Bush, PHD

Individual provider Clinical Psychologist · NPI 1003868514

Shane Bush, PHD is a Clinical Psychologist in Lake Ronkonkoma, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2006
Specialties on file
3
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

290 Hawkins Ave Ste B
Lake Ronkonkoma, NY 11779-9600
Phone: (631) 334-7884
Fax: (631) 980-3715
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Neuropsychologist (primary) Taxonomy 103G00000X · Licence 012998 (NY)
Clinical Psychologist Taxonomy 103TC0700X · Licence 012998-2 (NY)
Rehabilitation Psychologist Taxonomy 103TR0400X · Licence 012998 (NY)

Record details

NPI number1003868514
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedMay 16, 2006
Last updated in NPPESJuly 18, 2007